Vertebra kompresyon kırığı

Özet

Vertebra kompresyon kırığı travma, osteoporoz veya tümöral kemik zayıflaması sonrasında korpusun ön, orta ya da tüm yüksekliğinde çökme olarak görülür. BT, kortikal kırık hattını, son plak çökmesini, arka duvar retropulsiyonunu ve posterior eleman hasarını göstererek kırığın morfolojisini ve kanal daralmasını tanımlar. Kemik algoritmalı sagittal ve aksiyel görüntüler temel incelemedir; malignite veya epidural yumuşak doku kuşkusunda MRG kemik iliği ve nöral yapıları daha iyi değerlendirir. Arka duvar parçası, instabil kırık paterni veya epidural kitle gözden kaçarsa spinal kanal ve omurilik basısı fark edilmeyebilir.

Faz ve pencere

Kontrastsız tanısal

Sagittal kemik penceresinde korpus ön/orta/arka kontur yüksekliği, son plak çökmesi, kortikal kırık çizgisi ve retropulse kemik parçası; aksiyelde pedikül, lamina ve posterior eleman devamlılığı incelenir. Kırığı göstermek için kontrast gerekmez.

Kemik algoritması tanısal

İnce aksiyel, koronal ve sagittal rekonstrüksiyonlar kırık hattının son plak ve posterior duvarla ilişkisini, retropulsiyonun kanal içindeki yerini ve eşlik eden posterior eleman kırıklarını netleştirir.

BT bulguları

• Korpus yükseklik kaybı — kama biçimli ön çökme, orta bölüm çökmesi veya korpusun yaygın yassılaşması.
• Son plak basamaklanması — üst ya da alt son plakta kortikal kesinti ve trabeküler kompresyon.
• Kırık çizgisi — korteksten spongioz kemik içine ilerleyen lineer açıklık; kemik pencere ve sagittal düzlemde takip edilir.
• Posterior duvar retropulsiyonu — kemik fragmanının korpus arka sınırından kanala doğru yer değiştirmesi ve kanal çapını daraltması.
• Posterior eleman kırığı — pedikül, lamina veya spinöz/transvers çıkıntı kırığı; eşlik eden gerilme bandı hasarı instabiliteyi düşündürebilir.
• Korpus kortikal destrüksiyonu — benign osteoporotik ve malign kompresyon kırıklarının görüntüleme bulguları örtüşebilse de, karakteristik görüntüleme özellikleri ayrımda yardımcı olabilir.
• Pedikül/posterior eleman litik tutulumu — vertebra korpusu dışındaki odaksal kemik yıkımı patolojik kırık lehinedir ancak tek başına özgül değildir.
• Epidural veya paravertebral yumuşak doku — kitle benzeri komponent maligniteyi düşündürür; travma sonrası kanama da yumuşak doku dansitesi yapabilir.
• İntravertebral vakum yarığı — çökmüş korpus içinde yatay veya çizgisel radyolüsent yarık görülebilir; osteoporotik vertebra kırığında kırık kaynamamasıyla ilişkili olabilir, ancak tek başına etiyolojiyi belirlemez.

Ölçütler ve sınıflamalar

AO Spine torakolomber yaralanma sınıflaması

AO Spine torakolomber sınıflamasında A3 inkomplet, A4 komplet burst kırıklarını ifade eder. Bu sınıflama travmatik torakolomber yaralanma morfolojisini tanımlar.

Normalde

Normal korpusta ön, orta ve arka yükseklik birbirine uyumlu, üst-alt son plak konturları düzgün ve kortikal halka kesintisizdir; arka duvar spinal kanala doğru bombeleşmez. Kırık şüphesinde komşu seviyeler ile karşılaştırarak kama deformitesini, yeni kortikal basamağı ve retropulse fragmanı gösterin; posterior elemanların sürekliliği de normal seviyedeki simetrik pedikül ve laminalarla kıyaslanır.

Ayırıcı tanı

Akut benign osteoporotik kırık

keskin sınırlı kırık çizgileri, retropulse köşe fragmanı ve korunmuş korteks görülebilir; kemik iliği ödemi için MRG daha duyarlıdır.

Malign patolojik kırık

kortikal/spongioz kemik destrüksiyonu, ekspansil arka kontur, pedikül tutulumu veya kitle benzeri epidural/paravertebral doku şüpheyi artırır.

Schmorl nodülü

akut Schmorl nodülü, porotik kırık ve spondilodiskiti taklit edebilir.

Eski kama deformitesi

akut kırık ile kronik deformiteyi ayırmada MRG temel görüntüleme yöntemidir.

Spondilodiskit

karşılıklı son plak erozyonu, disk aralığında değişiklik ve paravertebral inflamasyon kırık hattından farklı bir örüntüdür.

Tuzaklar

• Tek bir çökmüş vertebra yeni ve akut olmayabilir; eski BT veya grafi ile kıyaslayıp kortikal kenarların kronik yeniden şekillenmesini kontrol edin.
• Akut osteoporotik kırıkta pedikül ödemi ya da paravertebral kanama maligniteyi taklit edebilir; kitle benzeri doku ile düzgün ince kanama/ödemi ayırın ve gerektiğinde MRG kullanın.
• Kemik penceresinde kanal içi yumuşak doku sınırlı seçilir; belirgin retropulsiyon veya nörolojik bulgu varsa yumuşak doku penceresi ve MRG ile epidural alanı değerlendirin.
• Korpus yüksekliği korunmuş olsa da posterior eleman veya gerilme bandı yaralanması daha geniş instabilite paterninin parçası olabilir; posterior arkı aynı incelemede tarayın.

Kendini dene

1. T11'de tek son plak kırılmış, korpus arka duvarı sağlam ve yalnız ön yükseklik azalmış. AO Spine morfolojisi hangisidir?

   • A1 kama kompresyonu
   • A2 split kırık
   • A3 inkomplet burst
   • A4 komplet burst
   Cevabı göster

   A1 kama kompresyonu. A1 tek son plak kırığıdır ve arka duvarı tutmaz. A2 her iki son plağı içerir ancak arka duvarı tutmaz; A3 arka duvar ve tek son plağı, A4 arka duvar ile iki son plağı içerir.

2. Korpus çökmesine arka duvarın düzensiz yıkımı, pedikül litik odağı ve kitle biçimli epidural doku eşlik ediyor. En olası mekanizma nedir?

   • Malign patolojik kırık
   • Akut osteoporotik kırık
   • Schmorl nodülü
   • Kronik kama deformitesi
   Cevabı göster

   Malign patolojik kırık. Kortikal ve medüller destrüksiyonla birlikte pedikül odağı ve kitle benzeri epidural komponent malign patolojik kırığı destekler. Osteoporotik kırıkta tipik olarak kitle benzeri tümör uzanımı olmaz; Schmorl nodülü fokal son plak herniasyonudur; kronik deformite eski incelemede stabil kalır.

İlgili konular

• Litik kemik metastazı
• Sklerotik kemik metastazı
• Multipl miyelom kemik hastalığı
• Soliter plazmasitom

Kaynaklar

Bu sayfadaki 43 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.