Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment

Abstract

Introduction The role of magnetic resonance imaging (MRI) has recently been enhanced in the diagnosis of thoracolumbar fractures due to its ability to examine soft tissue injury. Material and methods We conducted a prospective study to analyze the usefulness of MRI in fracture diagnosis and its influence on treatment decision making. Thirty-three patients were enrolled after suffering an acute traumatic thoracolumbar fracture. Osteoporotic or pathologic fractures were excluded. Fractures were initially classified using X-ray and CT scan following the AO classification. Afterward, a selective MRI protocol was performed with T1 and T2-weighted FS/STIR sequences. Subsequently, fractures were classified according to the TLICS system and reclassified following the AO system. Analysis was performed before and after MRI, focusing on: diagnostic changes, occult fractures and differences in treatment decision making. Results Thirty patients (15 males, 15 females) with an average age of 39.9 years were studied. Forty-one fractures were initially diagnosed using plain X-rays and CT scans, while MRI diagnosed 50 fractures and 9 vertebral contusions. MRI modified our diagnosis in 40% of our patients (discovering 18 occult injuries), the classification of fracture pattern in 24% of the fractures (mostly upgrading type A to type B patterns) and the therapeutic management in 16% of our patients. Conclusions MRI seems to be a useful tool in the evaluation of thoracolumbar acute fractures, as it allows a better visualization of the posterior complex integrity and of the levels involved, offering additional information compared to traditional diagnostic tools.

Magnetic resonance imaging frequently changes classification of acute traumatic thoracolumbar spine injuries

“…A recent study with a relatively low number of patients (n030) indicated a high rate of change in the classification of spinal injuries after performing MRI compared with CT alone [6]. However, the results of that study are limited owing to the small sample size and the fact that further analyses of the PLC components, which are essential to the stability of the spine, were not made [6].…”

“…As a consequence, MRI is considered the standard or reference imaging modality for visualizing the posterior ligamentous complex (PLC), consisting of the supraspinous ligament (SSL), the interspinous ligament (ISL), the ligamentum flavum (LF), and the facet joint capsules (FJC) [6][7][8].…”

The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature

“…This resulted in a total number of 21 included articles of this review. Eight studies evaluated the agreement on PLC injury evaluation [15][16][17][18][19][20][21][22], another eight studies evaluated the accuracy of detecting PLC injuries [23][24][25][26][27][28][29][30] and one study evaluated both agreement and accuracy [31]. Four studies reported on different validity components of PLC injuries [32][33][34][35].…”

Classifying thoracolumbar fractures: role of quantitative imaging

“…Rupture of the ligaments is depicted as frank interruption of a normally dark ligament replaced by high signal intensity fluid. MR imaging accuracy has been reported to be higher for detecting supraspinous ligament and ligamentum flavum injuries, and slightly lower for interspinous ligament and facet capsular injuries (30).…”