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Chance-Type Fractures of the Thoracolumbar Spine: Imaging Analysis in 53 Patients

Mark P. Bernstein1,2, Stuart E. Mirvis1 and K. Shanmuganathan1

1 Department of Radiology, University of Maryland School of Medicine, Maryland Shock Trauma Center, Baltimore, MD 21201.
2 Present address: NYU Medical Center/Bellevue Hospital, 560 First Ave., New York, NY 10016.


Figure 1
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  		Fig. 1A —Chance fracture. Anteroposterior lumbar spine radiograph obtained after laparotomy in 28-year-old woman and corresponding line diagram show horizontal fracture line through L2 vertebral body across both pedicles and transverse processes. "Empty body" sign is present secondary to displaced L1 and L2 spinous processes.

 

Figure 2
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  		Fig. 1B —Chance fracture. Anteroposterior lumbar spine radiograph obtained after laparotomy in 28-year-old woman and corresponding line diagram show horizontal fracture line through L2 vertebral body across both pedicles and transverse processes. "Empty body" sign is present secondary to displaced L1 and L2 spinous processes.

 

Figure 3
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  		Fig. 2 —Chance fracture in 28-year-old woman. Cross-table lateral radiograph of lumbar spine shows fanning of spinous processes (double-headed arrow) and fracture extending through pedicle (between arrowheads) and into L2 vertebral body (single-headed arrow).

 

Figure 4
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  		Fig. 3A —Chance fracture in 18-year-old man. Transaxial CT image of L2 vertebral body shows superior articular processes of L2 are seen without their normal articulation with L1 inferior articular processes (arrows). Note left transverse process fracture (arrowhead). Findings represent naked-facet sign and signify distraction of posterior elements.

 

Figure 5
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  		Fig. 3B —Chance fracture in 18-year-old man. Coronal CT reformation confirms distraction of left facets (arrow) and fracture of right (arrowhead).

 

Figure 6
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  		Fig. 4A —"Dissolving pedicle" sign in 28-year-old woman. Three serial transaxial CT images of lumbar spine reveal progressive loss of definition of L2 left pedicle (arrow, B and C). Note right transverse process fracture (arrowhead, B).

 

Figure 7
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  		Fig. 4B —"Dissolving pedicle" sign in 28-year-old woman. Three serial transaxial CT images of lumbar spine reveal progressive loss of definition of L2 left pedicle (arrow, B and C). Note right transverse process fracture (arrowhead, B).

 

Figure 8
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  		Fig. 4C —"Dissolving pedicle" sign in 28-year-old woman. Three serial transaxial CT images of lumbar spine reveal progressive loss of definition of L2 left pedicle (arrow, B and C). Note right transverse process fracture (arrowhead, B).

 

Figure 9
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  		Fig. 4D —"Dissolving pedicle" sign in 28-year-old woman. Sagittal CT reformation depicts horizontal L2 Chance fracture through left pedicle and into vertebral body (arrow).

 

Figure 10
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  		Fig. 5A —Inversion recovery sagittal MR images of lumbar spine in 31-year-old man. Chance fracture of L1 shows marked high signal in interspinous ligaments and soft tissues (arrowheads). Bone marrow edema (arrows) is seen in pedicle and vertebral body.

 

Figure 11
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  		Fig. 5B —Inversion recovery sagittal MR images of lumbar spine in 31-year-old man. Low-signal fracture line seen centrally in posterior vertebral body (arrow) with surrounding edema represents MRI sandwich sign.

 

Figure 12
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  		Fig. 6A —Chance-burst fracture in 28-year-old man. Transverse CT section through T12 with burst fracture shows retropulsion of posterior vertebral body cortex (arrowhead).

 

Figure 13
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  		Fig. 6B —Chance-burst fracture in 28-year-old man. More caudal section than A through T12 shows "dissolving pedicle" sign on right (arrow) and naked-facet sign on left.

 

Figure 14
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  		Fig. 6C —Chance-burst fracture in 28-year-old man. Midsagittal (C) and parasagittal (D) CT reformations of thoracolumbar spine confirm Chance-type fracture of T12 with fracture line through pedicle (arrow, C). Note associated buckling and retropulsion of T12 posterior vertebral body cortex along with loss of vertebral body height anteriorly. Together, these findings represent Chance-burst combination injury. Note is also made of compression fracture of T11 (arrowhead, C).

 

Figure 15
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  		Fig. 6D —Chance-burst fracture in 28-year-old man. Midsagittal (C) and parasagittal (D) CT reformations of thoracolumbar spine confirm Chance-type fracture of T12 with fracture line through pedicle (arrow, C). Note associated buckling and retropulsion of T12 posterior vertebral body cortex along with loss of vertebral body height anteriorly. Together, these findings represent Chance-burst combination injury. Note is also made of compression fracture of T11 (arrowhead, C).

 

Figure 16
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  		Fig. 7 —Transverse CT image of mid abdomen in 9-year-old girl with Chance fracture. Small-bowel loops have diffuse mural thickening consistent with jejunal contusion. Foci of free intraperitoneal air are present signifying perforation. Hemoperitoneum is seen in right paracolic gutter (arrow).

 

Figure 17
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  		Fig. 8A —Diagrams show proposed mechanism of injury for Chance-type fractures. White arrow shows point of contact of seat belt and abdomen, and straight black arrows depict forces. Black circle represents axis of rotation. Representative segment of lumbar spine is illustrated in abdomen restrained by seat belt. On sudden deceleration, point of contact of seat belt and abdomen serves as fulcrum, or axis of rotation, about which all structures posterior are subject to flexion and distractive forces.

 

Figure 18
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  		Fig. 8B —Diagrams show proposed mechanism of injury for Chance-type fractures. White arrow shows point of contact of seat belt and abdomen, and straight black arrows depict forces. Black circle represents axis of rotation. With enough force, bone integrity is overcome and horizontal Chance fracture results. Curved arrows show axis of rotation.

 

Figure 19
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  		Fig. 8C —Diagrams show proposed mechanism of injury for Chance-type fractures. White arrow shows point of contact of seat belt and abdomen, and straight black arrows depict forces. Black circle represents axis of rotation. With weakening of fractured spine, initial flexion-distraction force begins to involve an axial load component, driving axis of rotation (curved arrows) posteriorly.

 

Figure 20
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  		Fig. 8D —Diagrams show proposed mechanism of injury for Chance-type fractures. White arrow shows point of contact of seat belt and abdomen, and straight black arrows depict forces. Black circle represents axis of rotation. Once axis of rotation (curved arrows) moves posterior to anterior vertebral body cortex, compression begins.

 

Figure 21
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  		Fig. 8E —Diagrams show proposed mechanism of injury for Chance-type fractures. White arrow shows point of contact of seat belt and abdomen, and straight black arrows depict forces. Black circle represents axis of rotation. With ongoing force, axis of rotation (curved arrows) continues to migrate posteriorly in further weakened spine allowing greater axial loads that ultimately cause vertebral body to burst.

 

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