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Case of the Month 11/06

66 year old female presents to the ED complaining of back pain.

Q: What’s wrong with this picture?

View answer

Compression fracture of T10.

Q: In this and other similar cases, which other diagnosis should be considered (and ruled out when deemed necessary) prior to patient discharge?

View answer

A burst fracture in which there is fracture of both the anterior and posterior edges of the vertebral body may cause bony fragments to protrude into the spinal column. While these are often very subtle on plain films, missed diagnosis can lead to devastating neurologic consequences. The example below includes plain film and CT of an L2 burst fracture which may have been missed if the posterior vertebral line was not examined closely on the lateral view.

Q: If you suspected this injury, which imaging study would you order next?

View answer

While MRI is the study of choice when there is a question of spinal cord injury, CT scanning is preferred (as well as normally easier to obtain from the ED) when there is a question of bony abnormality. CT would be the study of choice to rule out burst fracture in this patient.