Classificational problems in ligamentary distraction type vertebral fractures: 30% of all B-type fractures are initially unrecognised

Leferink, V. J. M.; Veldhuis, E. F. M.; Zimmerman, K. W.; Vergert, EM ten; Duis, ten Henk Jan

doi:10.1007/s00586-001-0366-6

Cited by 51 publications

(34 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As expected, most of the spine fractures occur at the thoracolumbar junction Th11-L2 and this is simply a reflection of the most common location of compression type fractures. In the patient population only two AO type B fractures are found, but as described in literature it could be possible that other AO type B fractures, especially those with ligamentous posterior injuries, were not diagnosed because MRI was not routinely performed [27]. As expected, average LSC scores are significantly higher for the surgically stabilized patients.…”

Section: Discussionsupporting

confidence: 51%

Spine fractures caused by horse riding

et al. 2006

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 51%

Spine fractures caused by horse riding

et al. 2006

View full text Add to dashboard Cite

“…As the designers of the AO classification have stated, some type B injuries are missed and classified as type A when only standard radiographs are available [9]. In their study, Leferink et al [8] found that 30% of type B fractures were unrecognized using traditional examination tools. The results of MRI changed our initial planned treatment in five patients, moving from a conservative to a surgical approach.…”

Section: Discussionmentioning

confidence: 99%

“…Early classifications were designed through the analysis of plain X-rays and CT scan, which are examination tools not completely able to show soft tissue anatomy [8,10,11,13]. With these, the suspicion of ligament injury has to be assessed by indirect indicators such as focal kyphosis, interspinous spacing, diastasis of the facet joints or more than 50% of anterior body compression [2,16,17].…”

Section: Introductionmentioning

confidence: 99%

“…This system has proven to be very helpful in identifying posterior instability and to set a guide for treatment. Consequently, recent studies propose that acute fractures should be analyzed with both CT and MRI scans [2,8,13,14], or even only MRI scans [10,21], to fully understand the extent of the injury and its grade of instability. However, little information is available regarding the impact and accuracy of MRI on fracture diagnosis and its help in treatment decision making.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2011

View full text Add to dashboard Cite

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.

show abstract

“…In fact, it has been demonstrated that distinguishing between these two fracture types based on radiographs and computed tomography alone is unreliable. 4,5 Finally, no correlation data between the two classification systems were presented, leaving the primary research question unanswered. The midsagittal diameter (MSD) of the spinal canal was measured to assess the degree of canal narrowing.…”

mentioning

confidence: 99%

Is there a difference between narrowing of the spinal canal and neurological deficits comparing Denis and Magerl classifications?

et al. 2011

View full text Add to dashboard Cite

We have read with great interest the retrospective study by Caffaro and Avanzi 1 evaluating the relation between narrowing of the spinal canal and neurological deficits in patients with burst-type fractures of the spine. The authors are to be commended for obtaining detailed neurological and radiological data in a large cohort of 227 patients. The authors conclude: 'The percentage of narrowing of the spinal canal proved to be a pre-disposing factor for the severity of the neurological status in thoracolumbar and lumbar burst-type fractures according to the classifications of Denis and Magerl.' Although this conclusion is mainly in accordance with previous findings, 2,3 we would like to comment on the methodological approach applied in the current study. One of the study objectives was to evaluate the correlation between the presence of neurological deficits and the degree of spinal canal narrowing by comparing the Denis and Magerl classifications. Patients with Denis burst-type fractures were selected for inclusion and were re-classified according to the Magerl classification (A3.1, A.3.3 and B1.2). The distance between the spinous processes was used to distinguish type A from type B fractures. However, the authors did not provide a cut-off level for this distance. Moreover, this type of measurement has never been validated as a measure to distinguish type A3 from type B1 fractures. In fact, it has been demonstrated that distinguishing between these two fracture types based on radiographs and computed tomography alone is unreliable. 4,5 Finally, no correlation data between the two classification systems were presented, leaving the primary research question unanswered. The midsagittal diameter (MSD) of the spinal canal was measured to assess the degree of canal narrowing. In 1994, Rasmussen et al.6 demonstrated that measurement of the mean transverse spinal area (cm 2 ) is a more accurate method for evaluating neural canal encroachment when compared with the MSD. In the discussion section, the authors presented data on the correlation between the presence of neurological deficits and the degree of spinal canal narrowing. Remarkably enough, patients with Frankel grades A, B, C and D were combined and compared with those without neurological deficits for this purpose. By using this dichotomous approach, the authors failed to support their conclusive finding by saying that 'the percentage of narrowing of the spinal canal proved to be a pre-disposing factor for the severity of the neurological status y'.Finally, and perhaps most importantly, the authors did not consider the impact of the vertebral level of injury in the analyses. Several studies have shown that a certain degree of narrowing of the spinal canal at the thoracic spine (medulla/ epiconus level) results in a higher risk of neurological deficits when compared with the lumbar spine (cauda equina level). 2,3Despite the impressive number of patients investigated, the authors failed to provide medical professionals with methodologically sound evidence. In o...

show abstract

Classificational problems in ligamentary distraction type vertebral fractures: 30% of all B-type fractures are initially unrecognised

Cited by 51 publications

References 22 publications

Spine fractures caused by horse riding

Spine fractures caused by horse riding

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

Is there a difference between narrowing of the spinal canal and neurological deficits comparing Denis and Magerl classifications?

Contact Info

Product

Resources

About