1. INTRODUCTION: FAST THORACIC SPINE FACTS
The most commonly injured levels in the spine are the cervicothoracic (C6, C7, T1, T2) and thoracolumbar (T11, T12, L1, L2) vertebrae. These segments are predisposed to mechanical forces because they are the transitional areas between the relatively fixed (via the rib cage) thoracic spine and the more mobile cervical and lumbar spines.
Compression fractures and fracture–dislocations occur with highest frequency at T12 and L1. Of these, 15% to 20% involve neurological injury.
Anterior compression fractures of the vertebral bodies are the most common spinal injury detectable on radiographs in all age groups. The following are contributing factors:
◗ The vertebral bodies are composed primarily of cancellous bone, which is structurally weaker than the cortical bone of the vertebral arches.
◗ An axial force applied through the spinal column often converts to a flexion force, resulting in compression of the vertebral bodies, with sparing of the vertebral arches. This occurs in falls, whether landing on the feet from a height or landing on the buttocks in a ground-level fall.
◗ The normal thoracic kyphosis always predisposes the thoracic spine toward more flexion.
Radiographs are the initial imaging study for thoracic spine problems, with the exception of high-risk trauma patients, who are evaluated by CT. However, if CT is not available, radiographs are indicated.
Computed tomography (CT) is the initial imaging study for high-risk trauma patients. One scan can evaluate for multi-system trauma: the head CT for the brain, the thoracic-abdominal-pelvic (TAP) scan for the viscera, and finally, all images of the spine can be derived ...
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