X-rays often need to be reviewed in the following circumstances:

1. Multiple trauma
2. Suspected spine injury – eg. MVA, fall from height
3. Acute back pain – to rule out bony pathology

AP and lateral X-rays:

Alignment

• anterior and posterior aspects of bodies.
• Spinous processes – alignment and interspinous distance pedicles

Bones

• obvious fractures
• avulsion eg. spinous or transverse processes
• lytic lesions/missing pedicle (“Winking Owl”) – tumor

Oblique X-rays:

The infamous “Scottie Dog”!!

Types of Fracture:

– by mechanism of injury

1. Flexion – anterior wedge type

1. Axial compression – “Burst” type, look for wide interspinous processes

1. Lateral compression – Lateral wedge type

1. Flexion Distraction – “Seat-belt” or chance #

1. Flexion-Rotation – Fracture-dislocation

Stability of Wedge-Compression Fractures

1. Above normal alignment – eg. 15 kyphosis at L3 would be unstable
2. < 40 may be unstable if the posterior ligaments are disrupted.

In general, if a fracture is seen or suspected from the plain X-rays, a CT scan is indicated to further delineate the pattern and assess stability.

The decision making regarding operative or non-operative treatment is complex and beyond the scope of this book and it is based on consideration of the fracture pattern, the patient and the extent of neurological involvement.

Attachments:

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