Travmatik spinal kanal retropulsiyonu BT bulguları

Özet

Yüksek enerjili aksiyel yüklenmede vertebra korpusunun arka duvarı parçalanarak kemik fragmanlarını spinal kanala itebilir; bu görünüm çoğunlukla burst kırığının parçasıdır. Kontrastsız ince kesit BT, fragmanın kemik kaynaklı olduğunu, hangi seviyede bulunduğunu ve kanalın kemik konturunun ne ölçüde daraldığını gösterir. Sagittal ve aksiyel rekonstrüksiyonları birlikte okumak, yalnız ön korpus çökmesini kanal içine taşmış arka duvar parçasından ayırır. BT'de kanalın açık görünmesi kord, konus veya kauda ekuina hasarını dışlamaz; bası ya da nöral yaralanma gözden kaçarsa kritik klinik bulgu rapora yansımayabilir.

Faz ve pencere

Kontrastsız tanısal: Kemik algoritmalı ince kesit aksiyel BT’de vertebra arka duvarından kopup kanalın ön konturuna taşan kemik fragmanı görülür. Sagittal ve aksiyel rekonstrüksiyonlar fragmanın kraniokaudal uzanımını, son plak kırığını ve spinal kanalın kemik konturundaki daralmasını gösterir; BT nöral dokudaki hasarı dışlamaz.

Önerilen pencereler: Kemik (G 1800 / M 400).

BT bulguları

Arka duvar fragmanı — kortikal parça vertebra korpusunun posterior sınırından kanala doğru yer değiştirir; kaynağı ve yönü sagittal planda izlenir.
Korpus burst morfolojisi — üst veya alt son plakta kırıkla birlikte arka duvarın da tutulması, basit anterior kama kompresyonundan ayrılır.
Spinal kanalın kemik lümeninde daralma — retropulse fragman ile karşı kanal duvarı arasındaki açıklık ve kanal konturu aksiyel kesitte, aynı seviyenin komşu seviyeleriyle karşılaştırılarak değerlendirilir.
Fragman lateralizasyonu — parçanın orta hatta mı, sağ ya da sol lateral reseste mi uzandığı belirtilir; pedikül/lamina ile devamlılığı aranır.
Retropulsiyonun segmentel kapsamı — sagittal rekonstrüksiyonda arka duvar kırığının kraniyal ve kaudal sonlanımı ile komşu seviyelerin ilişkisi not edilir.
Eşlik eden posterior eleman hasarı — pedikül, lamina, spinöz çıkıntı veya faset kırığı tension-band yaralanma olasılığını değiştirir.
Nöral değerlendirme sınırı — kemik penceresindeki BT kanal basısını tanımlar ancak kord, konus veya kauda ekina düzeyindeki ödem, kontüzyon veya epidural hematomu tek başına dışlamaz.

Ölçütler ve sınıflamalar

AO Spine torakolomber A alt tipleri: A1 tek son plak kompresyonunda arka duvar sağlamdır; A3 tek son plak ve arka duvarı içeren inkomplet burst, A4 iki son plak ve arka duvarı içeren komplet burst kırığıdır. Arka duvar tutulumu burst morfolojisini (A tipi) destekler; gerilim bandı bütünlüğünün bozulması (B tipi) veya translasyon (C tipi) varlığında bu bileşenler ayrı ayrı değerlendirilir ve sınıflandırılır.
TLICS: Morfoloji, PLC bütünlüğü ve nörolojik durum birbirinden ayrı bileşenlerdir; burst morfolojisi, arka bağ kompleksinin durumu ve klinik nörolojik muayene birlikte kaydedilir. Kemik pencere BT, retropulse parça ile spinal kanalın daralmasını tanımlar ancak nörolojik durumun derecelendirilmesi klinik muayene ve nöral yumuşak doku değerlendirmesi için MR gerektirir.

Normalde

Normal aynı seviyede vertebra korpusunun arka korteksi düzgün ve komşu korpusların posterior çizgisiyle uyumludur; spinal kanal ön duvarında kanala doğru çıkıntı yapan kortikal parça bulunmaz. Yaralı düzeyi bir üst ve alt vertebrayla sagittal planda karşılaştırın, ardından aksiyel kesitte pediküller arasındaki kanal konturunun daralıp daralmadığına bakın.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1338; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Kama kompresyon kırığı: ön korpus yüksekliği azalmıştır ancak arka duvar korteksi ve kanal ön konturu korunur.
Schmorl nodülü: son plakta sınırlı çökme ve çevresel skleroz görülür; posterior korteksten kanala uzanan akut parça yoktur.
Epidural hematom: kanal içinde yumuşak doku dansitesi kemik fragmanı gibi görünebilir; kemik penceresinde kortikal devamlılık ve yumuşak doku penceresinde dansite değerlendirilir.
Kronik retropulse parça: kenarları kortikeleşmiş, vertebra deformitesi yeniden şekillenmiş ve çevresinde akut kırık bulgusu sınırlı olabilir.
Artefakt veya kısmi hacim: tek kesitte görülen yalancı kanal kenarı kesintisi ardışık aksiyel ve sagittal görüntülerde doğrulanmaz.

Tuzaklar

Sagittal orta hat kesiti fragmanı kaçırabilir; parça lateral reseste kalıyorsa aksiyel görüntüde kanalın iki yanını ayrı ayrı tarayın.
Kanalda kemik fragmanı görülmesi kord yaralanmasının derecesini göstermez; nörolojik muayene ve gerektiğinde MR bulguları ayrı raporlanır.
Korpus yüksekliği kaybı tek başına burst tanısı koydurmaz; posterior duvarın kesintili olup olmadığını ve fragmanın kanala yer değiştirip değiştirmediğini doğrulayın.

Kendini dene

L1'de üst son plak kırığına posterior korteksin kanala doğru yer değiştiren parçası eşlik ediyor. Morfoloji hangisidir?
Cevabı göster
A3 inkomplet burst. Tek son plak ve posterior duvar tutulumu A3 inkomplet burst morfolojisine uyar. A1'de posterior duvar korunur; spinöz çıkıntı ve faset yaralanmaları farklı anatomik yapılardadır.
BT'de retropulse kemik fragmanı ve kanal daralması görülüyor; nörolojik işlev hakkında hangi çıkarım doğrudur?
Cevabı göster
BT kord hasarını dışlamaz. BT kemik parçasını ve kemik kanal konturunu gösterir; kord, konus veya kauda ekuina hasarını tek başına dışlayamaz. Diğer seçenekler BT'nin nöral yumuşak doku sınırını aşan sonuçlar çıkarır.

Kaynaklar

Bu sayfadaki 42 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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