Functional morphology of the spinal canal after endplate, wedge, and burst fractures

Changes in the canal diameter during physiological motions are important considerations in the treatment of patients who have a burst fracture with the presence of bony fragments, but without neurologic deficit. In this in vitro study, the changes in the soft-canal diameter of the thoracolumbar region, when intact and after different fractures, was investigated under several different loading conditions. The soft-canal diameter was clearly identified on the lateral radiographs by attaching a series of steel balls to the posterior longitudinal ligament and ligamentum flavum in the midsagittal plane. Endplate, wedge, and burst fractures were produced incrementally in 19 three-vertebrae human cadaveric spine specimens by high-speed impacts. After each injury, a series of functional lateral radiographs were taken. The minimal canal diameter (MCD) was obtained by digitizing the images of the steel balls on radiographs using a custom-designed computer program. In the intact specimens, the MCD at the disc level changed significantly in flexion, extension, and compression, when compared with the MCD in the unloaded neutral position. However, the changes were small. The MCD after endplate and wedge fractures changed in a similar way. However, after the burst fracture, the MCD at the bone fragment level increased remarkably by a distraction force. It also significantly improved by an anterior shear force in comparison to the corresponding MCD in the neutral position. However, this change was smaller than the change due to the distraction force.