Spinal Injuries In any examination of a traumatized spinal column,

the pathogenesis of the trauma including the site

External trauma, now especially common in traffic
accidents, cause various injuries to the spine.
Subluxations, dislocations and fractures can lead to
instability of the spinal column. Acute instability
means that spinal cord and spinal nerve function is
threatened immediately after trauma. Chronic
instability leads to improper stress with a resulting
increase in spinal deformity and neurological
complications. A precise diagnosis which has taken
into consideration the pathogenic mechanism is the
key to successful therapy. After the clinical
examination, a conventional x-ray examination is
routinely performed. This usually gives important
clues as to the nature of the trauma injuries. The task
of CT is, then, to demonstrate critical regions, provide
additional information for the evaluation of stability,
and to provide images of regions that are inaccessible
with conventional radiographic techniques.
affected by trauma and the type of movements which
result (hyperflexion, hyperextension, compression, or
rotation) should be taken into consideration. The
examination can, then, be objectively supplemented, if
necessary.
For better understanding of the fracture mechanism
and for classification of spinal fractures, a three-
column model was devised by Denis (Fig. 26-40).
Basically, any spinal fracture is considered to be stable
as long as the middle column remains intact.
Fig. 26-40. Three-column model (according to
Denis).

The complementary nature of plain radiographs and

computed tomography can be variably utilized in the
different sections of the spinal column.

Plain radiographs are more sensitive than CT

in demonstrating:
— posture of the spinal column,
— alignment of vertebral bodies,
— slight reduction in height of vertebral bodies and
disc space narrowing,
— discrete deformation of vertebral bodies,
— discrete subluxations,
— complex fractures.

CT is more sensitive than plain radiographs in

demonstrating:
— fractures in the vertebral circumference,
— disc deformity,
— deformity of the spinal canal,
— vertical fracture lines,
— surrounding soft-tissue processes (e.g. haematoma
or leakage of cerebrospinal fluid).
Includes the anterior longitudinal
Anterior ligament and the anterior two thirds
column: of the vertebral body, including the
disc.
Middle Includes the posterior third of the
column: vertebral body and disc, and the
posterior longitudinal ligament.

Posterior Includes the neural arch and

Despite their limited spatial resolution, sagittal and
column: articulations, including the
frontal secondary reformatted images are a helpful ligamentous apparatus.
supplement to plain radiographs. With them, bone
contours and soft-tissues can be accurately evaluated.
The classification system of McAfee and Magerl distinguishes six additional types of injuries (Fig. 26-41).

Fig. 26-41. Classification of spinal fractures (according to McAfee and Magerl).

Type 1: Impacted compression fracture (wedge fracture) involving the anterior column.

Type 2: Incomplete bursting fracture involving the anterior and middle columns.

Type 3: Complete bursting fracture involving all three columns.

Type 4: Chance fracture with hyperflexion in front of the vertebral body. Involves all three
columns.

Type 5: Flexion-distraction injury with flexion behind the anterior longitudinal ligament. Involves
all three columns.

Type 6: Translation injury. Fracture dislocation involves all three columns. May occur with or
without axial rotation.