Spinal injury and computerized tomography: a review of fracture pathology and a new approach to canal decompression.

The plain X-rays and CT scans of 23 cases of thoracolumbar and 18 cases of lower cervical (below C2) spinal compression fractures were compared. A new picture of the fracture pathology has emerged as several features consistently appeared and are described: a midline or slightly oblique split of the vertebral body; posterolateral fractures of the body in the region of the developmental neurocentral joint; fragments of the body displaced backwards into the canal at the level of the pedicles; oblique laminal fractures; and separation of the zygapophyseal rim in thoracolumbar fractures. With this more complete picture of the bony injury, in particular canal encroachment, a new method of anterolateral canal decompression has been tried and is described.