How frequently MRI modifies thoracolumbar fractures’ classification or decision-making? A systematic review and meta-analysis

Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology

“…A0: isolated posterior element fractures should not be included, as they represent minor injuries. C-type injuries should be excluded since they are accurately classified with CT only ( Vaccaro et al, 2013 ), ( Rajasekaran et al, 2017 ); 4) neurologically intact patients (N0), those with transient radiculopathy (N1), or when neurological assessment is unattainable (Nx); ( Aly et al, 2024 ) 5) Single or multi-level injuries; for multi-level injuries, only fractures with the highest AO classification should be included; ( Vaccaro et al, 2013 ) 6) patients aged 18 to 65.…”

“…MRI's impact on TLF management can be measured by its diagnostic impact: change in PLC status or fracture classification or therapeutic impact; a change in treatment decision from surgery to conservative or vice versa. ( Aly et al, 2024 )…”

“…The rate of change in AOSpine classification can be quantified as the transition from type A to type B injuries or vice versa due to changes in PLC status after MRI. ( Aly et al, 2024 ) The following should not be counted as a change in fracture classifications: ( Aly et al, 2024 ) 1) a change in classification from A-injuries subtype to another, for example, A1 to A3 due to disclosure of posterior vertebral wall injury or A3 to A4 due to disclosure of second endplate injury. MRI is not routinely utilized in clinical practice to detect bone fractures; 2) identifying mild compression fractures or bone marrow edema as their influence on decision-making is negligible; 3) identifying or grading intervertebral disc injury, as its role in decision-making is still debatable ( Kanezaki et al, 2018 ).…”

“…A recent meta-analysis reported that MRI can change TLFs classification in 17% and treatment decisions in 22% of cases. ( Aly et al, 2022b ), ( Aly et al, 2024 ), ( Pizones et al, 2011 ), ( Winklhofer et al, 2013 ), ( Durmaz et al, 2021 ) The considerable variability in the reported impact of MRI could be due to the methodological challenges in analyzing the impact of MRI on TLFs ( Aly et al, 2024 ). Previous research comprised a heterogeneous population regarding the fracture types, neurological status, and treatment modalities ( Aly et al, 2024 ).…”

“…( Aly et al, 2022b ), ( Aly et al, 2024 ), ( Pizones et al, 2011 ), ( Winklhofer et al, 2013 ), ( Durmaz et al, 2021 ) The considerable variability in the reported impact of MRI could be due to the methodological challenges in analyzing the impact of MRI on TLFs ( Aly et al, 2024 ). Previous research comprised a heterogeneous population regarding the fracture types, neurological status, and treatment modalities ( Aly et al, 2024 ). The impact of MRI was measured by either the rate of change in fracture classification or the change in treatment decisions after MRI compared to CT alone.…”