Can Burst Fractures be Predicted from Plain Radiographs?

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

“…Burst fractures are radiographically characterized by posterior vertebral body angle exceeding 100°, reduction in posterior vertebral height, widened interpedicle distance, posterior cortical line disruption, and posterior vertebral body break, which may be associated with varying degrees of canal stenosis [6,25]. However evaluation of such fractures on plain radiographs alone can result in misdiagnosis, with associated ligamentous injuries being missed and approximately 25% of burst fractures being misdiagnosed as compression fractures [8,17]. The treatment of burst fractures with neurologic deficits is controversial as decompression might not result in resolution of the deficits and neurologic status (and the degree of compression) might improve with time, regardless of decompression [30,31].…”

Classifying thoracolumbar fractures: role of quantitative imaging

“…A tailored CT scan covering the painful segment is recommended due to the low sensitivity of radiography for detecting vertebral fractures, ranging from 33-77%, according with the affected level, being lower in the upper thoracic spine and higher in the lumbar spine (6,20). When fractures are demonstrated on radiographs of patients with low energy trauma, we advocate to perform a CT scan including at least two vertebrae up and below the fracture, because it is well known that radiographs underestimate the severity of fractures, including instability, or misdiagnose burst fractures as anterior compression fractures (21,22). Therefore, radiographs alone cannot be used for surgical planning and additional CT scanning is mandatory for accurate fracture classification and treatmentdecision making (23).…”

Seizure induced lumbar burst fracture associated with conus medullaris-cauda equina compression

“…However, spine radiographs may miss 25% of burst fractures, hairline fractures and other non-displaced fractures (20,21). If a screening spine radiograph reveals a compression fracture, then a spinal CT must always be performed to search for a burst fracture, which may compromise the spinal canal space (1,4).…”