Dynamic canal encroachment during thoracolumbar burst fractures.
In the burst fractures seen clinically, often poor correlation exists between the neurological deficit and the canal encroachment measured on post-trauma radiographic images. The purpose of the present study was to determine whether the dynamic canal encroachment during the trauma is greater than the static canal encroachment posttrauma. We successfully produced burst fractures in nine of 15 fresh human cadaveric thoracolumbar spine specimens (T11-L1). The specimens were incrementally impacted in a high-speed trauma apparatus until fracture occurred. During the trauma, dynamic canal encroachments were measured using three specially designed transducers placed in the canal at the levels of the superior end-plates of the T12 and L1 and the T12/L1 disk. After the trauma, residual static spinal canal encroachments were measured from the radiographs of the specimens that were prepared with 1.6-mm diameter steel balls lining the canal in the midsagittal plane. We found that the average canal diameter was 16.6 +/- 1.3 mm and the static canal encroachment was 18.0% of the canal diameter. The corresponding dynamic canal encroachment was 33.3%. Thus, the dynamic canal encroachment was 85% more than the static measurement. The clinical significance of this study lies in providing awareness to the clinician that the dynamic canal encroachment is significantly greater than the static canal encroachment seen on posttrauma radiographs or computed tomography scans. The finding may also explain the clinical observation of poor correlation between the canal encroachment measured radiographically and the neurological deficit.
Panjabi
M M
MM
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Kifune
M
M
Wen
L
L
Arand
M
M
Oxland
T R
TR
Lin
R M
RM
Yoon
W S
WS
Vasavada
A
A
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D013909:Thorax