Evaluation of disc degeneration adjacent to AOspine A fractures: pre- and post-operative MRI analysis

Abstract

Introduction: The management of type A thoracolumbar fractures varies from conservative treatment to multiple level fusion. Indeed, although Magerl defined the type A fracture as a strictly bone injury, several authors suggested associated disc lesions or degeneration after trauma. However, the preservation of mobility of the adjacent discs should be a major issue. This study was conducted to analyze the presence of immediate post-traumatic disc injuries and to know if discs degenerate after receiving treatment. Methods: We retrospectively reviewed the files of 27 patients with an AOspine A fracture, corresponding to 34 fractures (64 discs) with pre and post-operative MRI (mean follow-up: 32.4 months). Based on Pfirrmann’s and Oner’s classifications of disc injuries, two observers analyzed independently the type of lesion in the discs adjacent to the fractured vertebra in immediate post-trauma and at the last follow-up. Results: The immediate post-traumatic analysis according to Pfirrmann’s classification found 97% of the cranial adjacent discs and 100% of the caudal discs classified Pfirrmann 3 or less. The analysis on the secondary MRI revealed that 78% of cranial adjacent discs and 88% of caudal adjacent discs still were classified Pfirrmann 3 or less. Conclusions: Since, the great majority of type A fractures does not cause immediate disc injuries, these fractures are, as described by Magerl, strictly bony injuries. The quality of the body reduction seems to prevent secondary degeneration. These results may encourage surgeons not to perform arthrodesis on type A fractures even for A3 and A4.

Comparative analysis of the efficacy and accuracy of magnetic resonance imaging (MRI) and contrast-enhanced CT for residual and new lesions after transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer

“…By comparing different types of iodized oil deposition in patients, we found that there were marked differences in clinical prognosis. Patients with a large area and uniform distribution of iodized oil deposition had a lower incidence of new lesions and better prognosis after surgery ( 22 , 23 ). Moreover, TACE is more effective than conventional chemotherapy in advance PHC treatment compared, which could effectively improve the tumor focuses of the patients.…”

Efficiency of a Novel Vertebral Body Augmentation System (Tektona™) in Non-osteoporotic Spinal Fractures

“…Its advantage over internal xation may therefore be the reduction of complications related to the instrumentation (rob breakage, infection, screw loosening…) and leaving free the discs adjacent to the fracture [10,11]. Additionally, Magerl A fractures have been described as strictly bony fractures, and the proper reduction of the vertebral body reduction seems to reduce the risk of secondary disc degeneration [12,13]. However, most of the available device only allow one try for the corporeal reduction, device with a nonrepeatable reducing movement and does not allow to target the area to be reduced.…”