Copyright

Computed

1978 by 1/u- Journal

of

P.

W.

R.
From

NYKAMP,

DUNN,
the

M.D.*,

M.D.*,

AND

Departtnents

J,
J.

Computed

tomography

lesions

nerve

roots

as

has

those

(spinal

that

stenosis

6,

I: A lateral
roentgenogram
2-A: Computed
tomography
2-B: A toniographic
scan

plasms,

dysraphism,

metatrophic
and

the
*

Scottsdale,

I 108

technique

Scottsdale
Arizona

used

spinal

and

spinal

has

been

85251

M,D.*,

Radiology,

such
cord

paraspinal

or
neo-

F.

M.D.*,

CHRISTENSEN,

Neurosurgery,
Hospital,

and

ARIZONA
Orthopedic

Surger,

Scottsdale

metrizamide

contrast

We

used

how

M.D.*,

SCOTTSDALE,

recently
a

so-called

medium
computed

in

the

subarachnoid

tomography

bursting

fracture

FIG.

neurofibroma,

henniation

of

described
Hospital.

A CASE

LEVY,

Memorial

Fracture

of the

with
7400

East

a lumbar

and
Osborn

disc),

tebra

produced

level

of the

a fragment
conus

space.

to clearly

first

reveal

lumbar

yen-

2-B

of the fracture
of the first lumbar
vertebra
does not show
the posteriorly
displaced
fragment.
scan of the normal
second
lumbar
vertebra
of the same patient,
for comparison.
of the first lumbar
vertebra
shows
the inverted-Y-shaped
fracture
with a fragment
displaced
into

and

Memorial

M.

to evaluate

the

syringomyelia,

dwarfism3,

Incorporaa-d

Sur,i-rv,

FIG.

Fig.
Fig.
Fig.

been

compress

OF

HUBBARD,

of Diagnostic
Scottsdale

spinal

Jiii,ii

Tomography
for a Bursting
of the Lumbar
Spine
REPORT

BY

and

Bone

compressing

the spinal

the

canal.

cord

at

the

medullanis.

without2
Case

Road,
A twenty-two-year-old

white

THE

Report
woman

JOURNAL

fell six meters,

OF BONE

AND

landing

JOINT

on her

SURGERY

COMPUTED
feet

and

tion

from

tion

showed

the

falling

then

lower

The

was

impossible.

muscles

on

grams

of both

the

left

had

were

hyperesthesia

on

fracture

Neural

tibial)

in

area

supplied

in the anal

and dorsiflexion

displacement

foot,

stimulation.
first

improvement
in

of the

with

Computed

tomography

pointed

medullaris

(Figs.

The
pression

2-A

patient
of the

showed

fragment
and

was
cord

an inverted-Y-shaped

displaced

fracture

millimeters

toward

with

with

done

bed

after

rest

four

initially

weeks

but

when

surgical
she

moved.

The

lumbar
patient

canal.
tures

decom-

failed

SPINE

After

laminectomy

vertebra

which

improved

1 109

for exposure,
was

markedly

Sometimes
as in our

demonstrate,
nature
and

the conus

2-B).

treated
was

seven

the third

explodes.
neural
canal,

vertebral

1).

a sharp,

neurally.

from

LUMBAR

pressing
after

a bone

fragment

on the conus

the

was

re-

decompression.

So-called
bursting
fractures
are caused
by vertical
compression
of the vertebral
column,
forcing
the end-plate
or nucleus
of the disc into the vertebral
body,
which

and the

vertebra

of a portion

THE

Discussion

foot

Roentgeno-

lumbar

OF

sphinc-

of the right

of the left

plantar
of the

institu-

and

the

FRACTURE

examina-

ankle,

tone

of dorsiflexion

downward

posterior

muscle

A BURSTING

to our

back.

(patellar,

weak

FOR

transferred

in the

weak

no loss

a compression

a questionable

body(Fig.

was

moved

was

She
hips

was

pain

reflexes

there

nerve.

There

showed

only

and

sacral

She

of severe

decreased

extremities,

ter.

buttocks.

because

markedly

by the second

toes

on her

elsewhere

TOMOGRAPHY

to show

a fragment
is displaced
into the
patient.
In this case we were able to

by computerized
tomographic
position
of the fracture
in relation

With the
themselves

newer
often

types of scanners,
can be seen.

scanning,
the
to the neural
the

nerve

struc-

References
1. COIN, C. G.; CHAN,
Y.-S.;
KERANEN,
VICTOR;
and PENNINK,
MENNO:
Computer
Assisted
Myelography
in Disc
Disease.
J. Computer
Assisted
Tomog.
,
1: 398-404,
1977.
2. GLENN,
W.
V.:
New
Multiplanar
CT.
Display
Capabilities:
Applications
in the
Spine.
Presented
at Symposium
Ganzk#{246}rperComputertomographie.
Heidelberg,
September
9 to October
1 , 1977.
3. HAMMERSCHLAG,
S. B.; WOLPERT,
S. M.; and CARTER,
B. L.: Computed
Tomography
of the Spinal Canal. Radiology,
121: 361-367,
1976.
4. JAMES,
H. E., and OLIFF, MICHAEL:
Computed
Tomography
in Spinal
Dysraphism.
J. Computer
Assisted
Tomog.
, 1: 391-397,
1977.
5. NAKAGAWA,
HIR0SHI;
HUANG,
Y. P.; MALlS, L. I.; and WOLF, B. S.: Computed
Tomography
of Intraspinal
and Paraspinal
Neoplasms.
J. Computer
Assisted
Tomog.
,
1: 377-390,
1977.
6. TAVERAS,
J. M., and WooD,
E. H.: Diagnostic
Neuroradiology.
Ed. 2, vol. 2. Baltimore,
Williams
and Wilkins,
1976.

Copyright

Ewings
Delineated

975

by

The

Jotictial

o/

N.

B.

TUROFF,

M.D.*,

MELVIN

From
New

Ewings

sarcoma

lethal

has

primary

thopaedic

bone

surgeon.

chemothenapeutic

period

survival,

disease
have been
here computerized
their character.

regarded

many
decades.
metastatic

recognized,
tomognaphic

Jiii,it

.Siirgt-r.

M.D.*,

Bellevue

one
of the
by the orof modern

AND

Surgery

Medical

VOL.

and

Center,

manifestations

this
reported
to show

M.

M.

t 215

East

68th

60-A,

NO.

8, DECEMBER

Street,

New

1978

7F,
York,

New

N.Y.

York,
10021.

City

a nine-year-old

on October

24,

genographic
diaphysis

jacent

1974,

with

N.Y.

10010.

sarcoma

was

There
between

pain

received

3 1 , 1974,

specimen

Roentgenograms

and

marrow
was

The

in the distal

cavity

performed

Roent-

the

femoral

and

with

and

Ewings

ad-

of metastases.

of 4,500

rads

9,

He

1975.

and

included

was
months
(Fig.

part of the femur

to the
also

Cytoxan

Alkeran

chemotherapy
tumor

of

evidence

twenty-seven

residual

institution

so obtained.

September

actinomycin

made

no apparent

a lesion

in a dose

subsequently

(doxorubicin).

lar mineralization

the

to our

of the left femur.

or roentgenographic

including

showed

biopsy

radiotherapy

Treatment

admitted

part

in the

Open

from

no clinical

was

1) revealed

demineralization

diagnosed

October

boy,

in the distal

(Fig.

elevation.

was

The patient

nosis

mild

periosteal

Report

white

with

examination

phamide).

Apartment

York

Case

of

and in the case

scanning
helped

M.D.t,

Radiology,

New

chemotherapy,

Plaza,

LEWIS,

as

1976.
30 Waterside

MICHAEL

N.Y.

of Orthopaedic
-

ted

,,iil

Presentation
Tomography

Adriamycin
a

III(i,

A CASE

YORK,

with a more refined

more
patients
survive
During
the prolonged

coupled

of radiotherapy,
the case in past
some

been

Departments
University

tumors
encountered
With
the
advent

regimens

technique
than was
of

long

the
York

OF

BECKER,
NEW

most

tutu

Sarcoma:
Unusual
by Computerized
REPORT

BY

Bii,ii

(cyclophos-

(melphalan)

terminated
after

noted

and

in August

the initial

2). Patchy
were

femur

received

areas
and

diag-

of irreguwere

as-