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Chiropractic Research Review

Identification of Disc Injury Following Burst Fracture

Thoracolumbar burst fractures represent approximately 15% of thoracolumbar injuries; neurological deficit occurs in 50-60% of these injuries. Fractured vertebrae are easily recognized on radiographs, but identifying associated disc injuries may be more difficult.

Quantitative discomanometry (QD) may be superior to radiography when identifying disc injury by measuring disc pressure and the volume of saline solution that can be injected into the disc.

Fresh-frozen discs of nine five-vertebrae (T11-L3) specimens were examined using radiography and QD before and after burst fracture to L1. Burst fractures were produced in the specimens with a 3.6 kilogram or greater mass, as necessary,
dropped from 1.4 meters until fracture was observed in L1; other vertebrae were not fractured in all specimens.

QD revealed disc injuries in the discs adjacent to the injury in all cases after burst fracture, as well as disc injury to the lower next-adjacent level. Although radiography detected injuries to the two discs adjacent to L1, it detected no injuries to the next-adjacent discs.

The authors conclude that clinicians should suspect disc injury to next-adjacent discs below burst-fractured vertebrae, in addition to injuries to the adjacent discs. QD may be a more sensitive tool than radiography for determining the integrity of spinal discs.

Wang JL, Panjabi MM, Kato Y, et al. Radiography cannot examine disc injuries secondary to burst fracture: Quantitative discomanometry validation. Spine 2002:27(3), pp. 235-240.

Chiropractic Research Review

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