Three-Dimensional Computed Tomographic Imaging in the Diagnosis of Vertebral Column Trauma: Experience Based on 21 Patients and Review of the Literature

OBJECTIVE To compare standard x-ray films, two-dimensional computed tomographic reconstructions and three-dimensional (3-D) computed tomographic reconstructions for assessing the grade, extent, and severity of vertebral fracture. PATIENTS AND METHODS 3-D images were created from standard computed tomographic scans obtained using a General Electric PACE scanner. In 21 patients (17 men and four women) these images were obtained during both the acute phase and at long-term follow-up; there were six cervical, four dorsal, five dorsolumbar, and six lumbar fractures. RESULTS The 3-D images supplied useful information in complex traumas with rotation and/or dislocation of the vertebral body and in cases with loss of spinal alignment. The 3-D images also proved to be useful as an adjunctive imaging method for evaluation of bone fusion integrity. CONCLUSION 3-D images produced by recently available software provide a 3-D understanding much more readily than do multiple two-dimensional images. Because it would be very difficult to standardize this method of imaging, it seems best that the specialist (orthopedic surgeon, neurosurgeon, neuroradiologist) be present during the investigation to decide the viewing angles. An important limitation to this method is the presence of degenerative disease or osteoporosis, mainly in elderly patients.