Lumbar spine trauma. The structures of the lumbar spine can be considered as 3 columns. Trauma to the lumbar spine may result in injury limited to the anterior, middle, or posterior column, or it may involve multiple spinal columns, resulting in gross instability.

Lumbar spine trauma. Lateral drawing of the 3 spinal columns of the thoracolumbar junction. The anterior column (black dotted line) includes the anterior spinal ligament, the anterior annulus fibrosis, the intervertebral disc, and the anterior two thirds of the vertebral bodies. The middle column (red dotted line) includes the posterior aspect of the vertebral bodies, the posterior annulus fibrosis, and the posterior longitudinal ligament. The posterior column (thick blue dotted line) includes all of the spine posterior to the longitudinal ligament (thick blue dotted line).

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Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Axial CT image demonstrates a compression fracture of the upper lumbar spine. Note the comminuted fracture pattern.

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Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Sagittal reformatted CT image demonstrates fracture of the anterior L1 vertebral body with a posterior fragment displaced into the spinal canal (black arrow). The fracture extended into the spinous process (yellow arrow). A second fracture in the L3 vertebral body is noted in the posterior aspect of the inferior endplate of the L3 (white arrow).

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Lumbar spine trauma. A 35-year-old man presented to the emergency department after a motor vehicle accident. He complained of back pain without paresthesias or weakness of his lower extremities. Sagittal reformatted CT image demonstrates fracture of the anterior L1 vertebral body with a posterior fragment displaced into the spinal canal (black arrow). The fracture extended into the spinous process (yellow arrow). A second fracture in the L3 vertebral body is noted in the posterior aspect of the inferior endplate of the L3 (white arrow).

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Lumbar spine trauma. Drawing of the mechanism of injury of the lumbar spine burst injury is compared with an axial CT image. The centrally applied vertical force results in radial expansion of the vertebral body endplate. The posterior margin of the endplate may be displaced into the spinal canal (arrow).

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Lumbar spine trauma. Coronal view of a multiplanar reformatted image of the lumbar spine. Spinal compression fractures are identified at the L2 and L5 levels. The vertical forces (yellow arrows) have resulted in posterior displacement of a bone fragment into the spinal canal at the L2 vertebral body. As a result of a single traumatic event, compression fractures of the L2 and L5 have occurred. The coronal multiplanar reformatted image demonstrates more completely the vertical nature of the fracture patterns of the L2 and L5 (yellow arrows).

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Lumbar spine trauma. Axial CT (right) and axial MRI (left) images of an upper lumbar spine burst injury. While the CT image presents better detail concerning the bone injury, the MRI image fully illustrates the position of the conus.

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Lumbar spine trauma. Sagittal T1-weighted MRI of the lumbar spine demonstrates a severe degree of compression of the L1 vertebral body (arrow). More than 60% of the vertical height of the L1 has been lost due to a compression failure of the L1 body.

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Lumbar spine trauma. Two contiguous sagittal T2-weighted MRIs of the lumbar spine demonstrate a compression fracture of the L1 vertebral body. The anterior aspect of the L1 is compressed more than 60%. The posterior margin of the fracture encroaches into the spinal canal at the L1 level.

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Lumbar spine trauma. Two contiguous sagittal T2-weighted MRIs of the lumbar spine demonstrate a compression fracture of the L1 vertebral body. The anterior aspect of the L1 is compressed more than 60%. The posterior margin of the fracture encroaches into the spinal canal at the L1 level.

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Lumbar spine trauma. Sagittal T1-weighted MRI of the lumbar spine. A 40-year-old man without any preceding event presented with sudden severe low back pain after lifting at work. He underwent chiropractic manipulation without relief of pain. The pain radiated into his right thigh. Lumbar spine findings were abnormal, and additional studies were performed.

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Lumbar spine trauma. Axial CT images of an L2 compression burst fracture after posterior fusion with pedicle screws (yellow arrow) joined by a posterior bar (white arrow). The pedicle screws should be entirely within the bone of the body and pedicle of the vertebral bodies.

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Lumbar spine trauma. Lateral view of the lumbar spine demonstrates a compression fracture (arrow). Because the patient's pain was of recent onset, the fracture was considered to be acute. The loss of vertebral body height is less than 50%. The patient was considered to be a good candidate for treatment with vertebroplasty.

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