A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

Abstract

OBJECTIVE:To evaluate the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures.METHODS:Fifty-six cases of thoracolumbar vertebral fractures treated in our trauma center from October 2012 to October 2013 were included in this study. The fractures were classified by the anteroposterior classification, whereas the severity of intervertebral disc injury was evaluated using magnetic resonance imaging. The Spearman correlation coefficient was used to analyze the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar fractures, whereas a χ2 test was adopted to measure the variability between different fracture types and upper and lower adjacent disc injuries.RESULTS:The Spearman correlation coefficients between fracture types and the severity of the upper and lower adjacent disc injuries were 0.739 (PU<0.001) and 0.368 (PL=0.005), respectively. It means that the more complex Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications are the disc injury is more severe. There was also a significant difference in the severity of injury between the upper and lower adjacent discs near the fractured vertebrae (p<0.001).CONCLUSIONS:In thoracolumbar spinal fractures, the severity of the adjacent intervertebral disc injury is positively correlated with the anteroposterior fracture type. The injury primarily involves intervertebral discs near the fractured end plate, with more frequent and severe injuries observed in the upper than in the lower discs. The presence of intervertebral disc injury, along with its severity, may provide useful information during the clinical decision-making process.

Magnetic resonance imaging evaluation of intervertebral disc injuries can predict kyphotic deformity after posterior fixation of unstable thoracolumbar spine injuries

“…Our study is advantageous because it investigated the association between kyphotic deformity and factors that can be evaluated on initial MRI scans, which are routinely performed in the assessment of spinal injuries. [ 21 , 22 ] Specifically, we used MRI scans to grade IDIs according to Sander's classification to investigate the correlation between IDI severity and fracture type. However, we could not find any correlation between kyphosis and these 2 factors.…”

Effects of Endplate Healing Morphology on Intervertebral Disc Degeneration after Pedicle Screw Fixation for Thoracolumbar Fractures

“…As the severity of the fracture increases, the form of intervertebral disc injury can also manifest as intervertebral disc edema, intradisc hemorrhage, the nucleus pulposus protruding into the vertebral body, or even a complete tear. In our previous study, we also found that the severity of the injury to the adjacent intervertebral disc in thoracolumbar fractures was positively correlated with the type of Magerl AO fracture [17]. When the nucleus pulposus protrudes into the vertebral body, the volume of the intervertebral disc decreases, the height of the intervertebral space decreases, and the pressure in the vertebral body increases, which breaks the balance of the pressure difference between the subchondral bone and cartilage endplate and then affects the diffusion of nutrients to the intervertebral disc, leading to intervertebral disc degeneration.…”

Treatment of thoracolumbar fractures by temporary posterior instrumentation with selective fusion schemes

“…In our study, the non-fusion procedures were not an optimal option for their treatment. Also, the literature suggested fused schemes only after an abnormal signal of intervertebral disc was prominent [7,11]. Hence, we proposed the selective fusion or limited fusion schemes for the TLF with short-segment instrumentation, i.e., the vertebrae above and below the fractured vertebrae that preserved not only the motion of the spine postoperatively but also, stabilized the fracture, and restored the spinal alignment.…”

“…However, the best treatment and surgical indications of TLF, especially for the fusion procedure are still controversial [4][5][6]. Fusion generates de nite immediate bene ts and late stability, such as vertebral body height loss beyond 40%, an abnormal signal in the intervertebral disc, and rupture of the inter-spinal ligament [7]. Although the fusion of mobile segments solves the problem of instability, it restricts the movement of the spine.…”