E1615. Cracking the Back: Decoding Brittle Spine Fractures in Patients with Autofusion
  1. Sydney Payne; Stanford University Medical Center
  2. Bryan Lanzman; Stanford University Medical Center
Spinal fractures in patients with rigid spines are difficult to detect yet have potentially devastating complications. The prevalence of ankylosing spondylitis (AS) is reported as 0.1 - 1.4 %, with a sevenfold increase in the incidence of spinal fractures compared to the general population. Diffuse idiopathic skeletal hyperostosis (DISH) is reported to be 25% in men and 15% of women over 50 years of age. These patients with rigid spines have altered spinal biomechanical properties and a long rigid spine lever arm, which results in greater fracture risk even with minor trauma. In addition, these patients have a heightened risk of falling due to impaired mobility directly related to having a rigid spine. When a fracture does occur in this patient population, often all three spinal columns are involved, resulting in unstable fractures and predisposing the patient to spinal cord injury (SCI). Due to unfamiliarity with fracture patterns in patients with a rigid spine, fracture diagnosis is often delayed which leads to increased morbidity and mortality [3]. Correct and timely identification of brittle spine fractures and their related imaging features will lead to quicker diagnosis and guide appropriate surgical management.

Educational Goals / Teaching Points
This educational exhibit will illustrate common patterns of injury of brittle spine fractures, focusing on patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis. In addition, this exhibit will provide examples of relevant imaging features of injury associated with brittle spine fractures to fully characterize the extent of injury.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Altered biomechanical properties of rigid spines predispose patients to fracture while extensive bony dystrophic changes and spinal deformities create diagnostic challenges. Several patterns of brittle spine fractures are commonly seen, such as a hyperextension mechanism with distraction injury, preferential location of fracture through the intervertebral disk in AS verses vertebral body in DISH, multiple noncontiguous fractures, posterior extension of fractures, and associated injuries such as spinal cord injury, epidural hematoma, and ligamentous complex injuries.

Early and accurate detection of brittle spine fractures and careful assessment for relevant imaging features is critical to guide timely and correct management, as well as to prevent morbidity and mortality. Due to high prevalence of brittle spines and their high fracture risk, all trauma patients with brittle spines should be assumed to have a fracture until proven otherwise, regardless of the mechanism of injury. Understanding the patterns of injury and the imaging features associated with these fractures can help direct the radiologist to a precise diagnosis.