Case #2

• Acute L1 vertebral body fracture with approximately 30% height loss and 6 mm bony retropulsion with resultant advanced spinal canal stenosis at this level
• Ventral epidural hematoma extending inferiorly from the L1 fracture to the level of the L4 superior endplate, measuring up to 5 mm in thickness with resultant advanced spinal canal stenosis at L1-L2, moderate spinal canal stenosis at L2-L3, and mild spinal canal stenosis at L3-L4
• Possible focal disruption of the anterior and posterior longitudinal ligaments at the level of L1
• T2/STIR signal hyperintensity in the T12-L1 interspinous ligament and in the supraspinous ligament at the level of T12 with focal disruption
• Prevertebral edema from L1-L2
• T1/T2/STIR hyperintense lesions in the T12 and L3 vertebral bodies, likely representing atypical vertebral venous malformations (hemangiomas)
• Disc dessication and height loss at L5-S1
• Facet hypertrophy and ligamentum flavum thickening contribute to mild bilateral neural foraminal stenosis at L4-L5 and L5-S1
• Conus terminates in normal position without signal abnormality
• Trace anterolisthesis at L4-L5

• Epidural hematoma
• Ligamentous injury

• Always be on the lookout for epidural hematomas in the setting of trauma, as these can sometimes result in more symptomatic cord and nerve root compression than the fractures themselves
• Expect to see ligamentous injury when you see a fracture involving more than one column
• In particular, make sure to assess the integrity of the posterior ligamentous complex (PLC), which consists of the following:
  • Supraspinous ligament
  • Interspinous ligaments
  • Facet joint capsules
  • Ligamentum flavum

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