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    Head and Neck Imaging

    Injuries to the Rigid Spine: What the Spine Surgeon Wants to Know

    Published Online:Feb 1 2019https://doi.org/10.1148/rg.2019180125

    Abstract

    Rigid spine entities, a group of conditions that can alter the biomechanics of the spine, manifest with particular fracture patterns after trauma; understanding the relevant imaging features can help determine if surgical intervention is required and can help avoid a missed or delayed diagnosis of an injured rigid spine.

    The biomechanical stability of the spine is altered in patients with a rigid spine, rendering it vulnerable to fracture even from relatively minor impact. The rigid spine entities are ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis, degenerative spondylosis, and a surgically fused spine. The most common mechanism of injury resulting in fracture is hyperextension, which often leads to unstable injury in patients with a rigid spine per the recent AOSpine classification system. Due to the increased risk of spinal fractures in this population, performing a spine CT is the first step when a patient with a rigid spine presents with new back pain or suspected spinal trauma. In addition, there should be a low threshold for performing a non–contrast-enhanced spine MRI in patients with a rigid spine, especially those with AS who may have an occult fracture, epidural hematoma, or spinal cord injury. Unfortunately, owing to insufficient imaging and an unfamiliarity with fracture patterns in the setting of a rigid spine, fracture diagnosis is often delayed, leading to significant morbidity and even death. The radiologist’s role is to recognize the imaging features of a rigid spine, identify any fractures at CT and MRI, and fully characterize the extent of injury. Reasons for surgical intervention include neurologic deficit or concern for deterioration, an unstable fracture, or the presence of an epidural hematoma. By understanding the imaging features of various rigid spine conditions and vigilantly examining images for occult fractures, the radiologist can avoid a missed or delayed diagnosis of an injured rigid spine.

    ©RSNA, 2019

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    Article History

    Received: Apr 1 2018
    Revision received: May 15 2018
    Revision requested: June 12 2018
    Accepted: June 15 2018
    Published online: Feb 01 2019
    Published in print: Mar 2019