The utility of whole spine survey MRI in blunt trauma patients sustaining single level or contiguous spinal fractures

Atsina, Kofi-Buaku; Rozenberg, Aleksandr; Selvarajan, Santosh Kumar

doi:10.1007/s10140-019-01693-0

Cited by 10 publications

(11 citation statements)

References 32 publications

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“…Further, multilevel contiguous osteoporotic lumbar compression fractures have been described 31 . Also in non-osteoporotic patients multilevel vertebral injuries are common and incidences around 20-30% have been reported [32][33][34] . Especially occult, non-continuous vertebral injuries bare the risk of delayed diagnosis.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of vertebral fractures in the adult German population and an analysis of the socio-economic burden: Trends from 2009 to 2019.

Lang

Walter

Freigang

et al. 2022

Preprint

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ObjectiveTo present nationwide rates of hospitalized patients with vertebral fractures over one decade and a comprehensive analysis of treatment characteristics and incurred costs in 2019.MethodsTrends in the incidence were quantified based on annual ICD-10 diagnosis codes from all German medical facilities between 2009 and 2019, provided by the Federal Statistical Office (Destatis). The ICD-10 Codes “S12.0-2; S22.0; S32.0; S32.1-2” were evaluated. The relative change from 2009 through 2019 was determined and data on the secondary diagnoses, OPS-codes, treatment on an intensive care unit (ICU), in-hospital mortality, proportion of G-DRGs and cumulative costs were assessed based on the Institute for the Hospital Remuneration System (InEK) data for 2019.ResultsThe incidence increased by 45.6% between 2009 and 2019 to 150.7 per 100,000 inhabitants. Lumbar spine fractures showed the highest incidence in 2019 with 70.5/100,000 inhabitants (46.8% of all vertebral fractures). The highest increases were seen in subaxial cervical fractures (+121.2%) and sacral fractures (+306.6%). 63.7% of vertebral fractures in 2019 were diagnosed in women and 69.0% in patients ages 70 years or older. Osteoporosis was documented in 17.9% of cases. In 10.1% of cases an ICU treatment was documented. The in-hospital mortality was 2.0%. The most frequently applied G-DRG code was I68D (33.3%). The total costs in 2019 were €589,205,715.ConclusionThe evaluation of 955,091 vertebral fractures showed a sharp increase in the incidence rate with incurred cost of approximately €590 million in 2019. The age and gender distribution suggests an increase in the diagnosis of osteoporotic fractures.

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Section: Discussionmentioning

confidence: 99%

The epidemiology of vertebral fractures in the adult German population and an analysis of the socio-economic burden: Trends from 2009 to 2019.

Lang

Walter

Freigang

et al. 2022

Preprint

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“…32 Besides the initial diagnostic with conventional radiography and CT, the gold standard for diagnosing bone marrow edema and disc edema, such as in nondisplaced spine trauma, is MRI, although its ability to detect fractures may vary depending on the etiology, namely osteoporotic versus malignant causes. 1,33 MRI identifies subtle bony edema seen in compression fractures that would otherwise be missed by conventional radiography. For stress fractures in the lumbar spine, the sensitivity was reported at 99.6%, specificity at 86.7%, and accuracy at 97.2%.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, the gold standard for the detection of vertebral injuries and relevant soft tissue injury is magnetic resonance imaging (MRI). 1 In an acutely injured spine, MRI is better able to detect diagnoses, such as bone marrow edema or acute spinal stenosis. However, use of MRI is limited by its time-intensive nature and high costs, and patients need to be free of any implanted metal devices, such as pacemakers or brain stimulators.…”

Section: Introductionmentioning

confidence: 99%

Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis

Bäcker

Perka

et al. 2021

Int J Spine Surg

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Background: The purpose of this study was to perform a systematic literature review and meta-analysis to evaluate the sensitivity, specificity, and accuracy of dual-energy computed tomography (DE-CT) of bone marrow edema and disc edema in spine injuries. In vertebral injuries, prompt diagnosis is essential to avoid any delays in treatment. Conventional radiography may only reveal indirect signs of fractures, such as when it is displaced. Therefore, to detect the presence of bone marrow or disc edemas, adjunctive tools are required, such as magnetic resonance imaging (MRI) or DE-CT.Methods: Search terms included ((DECT) OR (DE-CT) OR (dual-energy CT) OR ''Dual energy CT'' OR (dualenergy computed tomography) OR (dual energy computed tomography)) AND ((spine) OR (vertebral)), and the PubMed, EMBASE, and MEDLINE databases and the Cochrane Library and Google were used. We found 1233 articles on our preliminary search, but only 13 articles met all criteria. Data were extracted to calculate the pooled sensitivity, specificity, and diagnostic odds ratio for analysis using R software.Results: Within the 13 studies, 515 patients, 3335 vertebrae, and 926 acute fractures (27.8%) defined by MRI were included. The largest cohort included 76 patients with 774 vertebrae. In 12 publications, MRI was reported for comparison. For DE-CT, the overall sensitivity was 86.2% with a specificity of 91.2% and accuracy of 89.3%. Furthermore, 5 studies reported the accuracy of CT with an overall sensitivity of 81.3%, specificity of 80.7%, and accuracy with 80.9%. Significant differences were found for specificity (P , .001) and accuracy (P ¼ .023). However, significant interobserver differences were reported.Conclusions: DE-CT seems to be a promising diagnostic tool to detect bone marrow and disc edemas, which can potentially replace the current gold standard, the MRI.Level of Evidence: 2.Clinical Relevance: This study shows that DE-CT seems to be a promising diagnostic tool with an accuracy of 89.3%.

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“…In one recent study, findings on MRI changed management plans relatively infrequently in patients with thoracolumbar fractures without neurological deficit. 49 In another recent study, 18.5% of patients with single-level or contiguous vertebral fractures were found to have additional injuries on MRI, although the majority were bone contusions or simple compression fractures which did not alter management planning. 50 In patients with no fracture on CT, MRI of the cervical spine warrants consideration in patients with symptoms of central cord syndrome or midline tenderness and equivocal findings on CT. 51 Magnetic resonance imaging of the cervical spine can visualize soft tissue injury and is widely utilized to determine ligamentous stability in the unevaluable trauma patient, though clinical practice is variable (Figure 13).…”

Section: Magnetic Resonance Imagingmentioning

confidence: 92%

“…A number of complications have also been reported including but not limiting to misplaced access, soft tissue or articular cavity extravasation, compartment syndrome, or fat marrow pulmonary emboli. 48,49…”

Section: Technical Considerations In Wbctmentioning

confidence: 99%

Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making

et al. 2020

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Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient’s best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.

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The utility of whole spine survey MRI in blunt trauma patients sustaining single level or contiguous spinal fractures

Cited by 10 publications

References 32 publications

The epidemiology of vertebral fractures in the adult German population and an analysis of the socio-economic burden: Trends from 2009 to 2019.

The epidemiology of vertebral fractures in the adult German population and an analysis of the socio-economic burden: Trends from 2009 to 2019.

Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis

Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making

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