Radiological findings of February 2023 twin earthquakes-related spine injuries

Abstract

Background: The February 6, 2023, twin earthquakes in Türkiye caused significant structural damage and a high number of injuries, particularly affecting the spine, which underscores the importance of understanding the distribution and nature of vertebral injuries in disaster victims.

Aim: To investigate the distribution of radiological findings of vertebral injuries in patients referred to a major tertiary center during the February 6, 2023 twin earthquakes in Türkiye.

Methods: With the approval of the institutional ethics committee, 1216 examinations of 238 patients transferred from the region to a tertiary major hospital after the twin earthquakes of February 6, 2023, were retrospectively analyzed for spine injuries.

Results: Spine computed tomography (CT) scans were performed in 192 of 238 patients with a suspected spinal injury, 42 of whom also had an magnetic resonance imaging (MRI). In 86 of 192 patients (44.79%; M:F = 33:53) a spinal fracture was detected on CT and in 33 of 42 patients (78.57%; M:F = 20:13) a spinal injury was found on MRI. Of the 86 patients in whom vertebral injury was detected, fractures were detected in the Denis-B group in 33, Denis-C in 4, Denis-D in 20 and Denis-E in 11 patients. Among the vertebral bodies: 40 "compression fractures", 17 "burst fractures", 5 "translational dislocation fractures", 5 "flexion-distraction fractures" and 58 "prolonged forced fetal posture fractures" were detected. In addition, isolated transverse or spinous process fractures were found in eighteen vertebrae.

Conclusion: Our study highlights the prevalence and diverse spectrum of spinal injuries following the February 6, 2023 twin earthquakes in Turkey underscoring the urgent need for effective management strategies in similar disaster scenarios, and emphasizing the "prolonged forced fetal posture" damage we encountered in earthquake victims who remained under the collapse for a long time.

Keywords: Accidental injuries; Compression fractures; Crush injuries; Earthquakes; Spine.

Figure 1

Prolonged fetal posture injury. A 23-year old male who jammed under debris about 15 minutes. A: Computed tomography image reveals T8 to L1 consecutive mild compression fractures (arrows), which corresponds to thoracolumbar area injury; B and C: T1W image and T2-STIR sequence show T8 to L1 vertebrae fracture and edema around them; D: The image of the volume rendering technique shows especially the fractures of the T12 and L1 vertebrae.

Figure 2

Compression fracture. A 27-year old male who was injured while escaping from the earthquake. A: Computed tomography image reveals T1-T5 vertebrae and T7 vertebra compression fractures (arrows); B and C: T2-STIR and T2W images show C6-T5 vertebrae and T7 vertebra compression fractures (arrows) and edema around them.

Figure 3

Flexion-distraction fracture. A 35-year old male who jammed under debris about 3 hours. A: Computed tomography image reveals the flexion-distraction type of fracture involving T12 to L4 vertebrae, especially with anteriorly losing height (orange arrows) and distraction of posterior processes (yellow arrows); B: STIR sequence shows fractures of T12 to L4 vertebrae and edema around fractures.

Figure 4

Burst fracture. A 63-year old female who jammed under debris about 48 hours. A: Computed tomography image reveals the burst fracture of the L4 vertebra (arrows) with the loss of height; B and C: T2W and STIR sequence show the retropulsed bone fragment and narrowing of the spinal canal (arrows).

Figure 5

Translation-dislocation fracture. A 52-year old male who jammed under debris about 12 hours. A: Sagittal reformat computed tomography (CT) image reveals the translation type of L4 vertebra fracture (arrow), extending into the right facet joint. B: Axial CT image of the same patient reveals the right transverse process fracture of L4 extending into the right facet joint.