Chapter 9: Spine

Introduction

The regions of the thoracic and lumbar spine include:

• Superficial compartment (upper limb muscles)

• Deep compartment (erector spinae)

• Vertebral compartment

The superficial and deep compartments are muscular and may not seem to have great clinical relevance, but in fact most pathology seen by the clinician in this region are muscular problems. However, they usually do not require imaging. The vertebral compartment is made up of vertebrae, vertebral canal, and intervertebral foramina. The contents of the vertebral canal are epidural fat and veins plus the spinal cord, nerve roots, cauda equina, and meninges. Clearly, this is where the most worrying pathology lies. The intervertebral foramina contain the exiting nerve roots. Here they are subject to compression by disc herniation and facet joint osteophytes.

Normal Images

Compression

Notes

Acute severe injury such as diving, fall from a height.

Report

Complete obliteration of L1 body consistent with a large vertical compression force.

Treatment

Hard to repair. Internal fixation.

Notes

Vertical compression or forced flexion forces (or both); may have pathology in body causing pathological fracture (e.g., tumor, infection, osteoporosis).

Report

L2 compression fracture with displacement and dural compression.

Treatment

Hard to repair. May need decompression of theca depending on symptoms and signs.

Notes

Vertical compression or forced flexion forces (or both); may have pathology in body causing pathological fracture (e.g., tumor, infection, osteoporosis).

Report

Severe anterior wedging of T6 and T7 leading to angular kyphosis.

Treatment

Hard to repair. Possibly internal fixation.

Notes