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

Abstract

Objective To evaluate the influence of additional (MRI) compared with computed tomography (CT) alone for the classification of traumatic spinal injuries using the Arbeitsgemeinshaft für Osteosynthesefragen (AO) system and the ThoracoLumbar Injury Classification and Severity (TLICS) scale. Materials and methods Images from 100 consecutive patients with at least one fracture on CT were evaluated retrospectively by three radiologists with regard to the AO and TLICS classification systems in 2 steps. First, all images from the initial CT examination were analyzed. Second, 6 weeks later, CT and MR images were analyzed together. Descriptive statistics and Wilcoxon tests were performed to identify changes in the number of fractures and ligamentous lesions detected and their corresponding classification. Results CT and MRI together revealed a total of 196 fractures (CT alone 162 fractures). The AO classification changed in 31 %, the TLICS classification changed in 33 % of the patients compared with CT alone. Based on CT and MRI together, the TLICS value changed from values <5 (indication for conservative therapy) to values ≥5 (indication for surgical therapy) in 24 %. Conclusion MRI of patients with thoracolumbar spinal trauma considerably improved the detection of fractures and soft tissue injuries compared with CT alone and significantly changed the overall trauma classification.

Evaluation of the safety and reliability of the newly-proposed AO spine injury classification system

“…The authors suggested that Magnetic Resonance Imaging (MRI) could be used for further investigation of ligamentous injuries and was found to be helpful in some cases. 18 In our study, 64.8% of the patients had total reproducibility between the newly AO spine groups (A, B and C), whereas only 55.2% had perfect concordance regards to sub-type classification. The Kappa index for major groups, A, B and C, was respectively 0.75 (good), 0.7 (good) and 0.85 (almost perfect).…”

“…For example, the controversial evaluation of the status of the Posterior Ligament Complex (PLC), are instead integrated into the A, B and C classification and potentially minimize inter-observer disagreement. 11,16,18 Moreover, it was designed primarily as a Computer Tomography (CT) classification, as these are widely available imaging modalities in trauma centers around the world. The authors suggested that Magnetic Resonance Imaging (MRI) could be used for further investigation of ligamentous injuries and was found to be helpful in some cases.…”

Classifying thoracolumbar fractures: role of quantitative imaging

“…Assessment of PLC is important because its failure significantly influences the severity of the fracture (52). In a recent study MRI increased the severity of CT score of TL fractures in 31% of patients and in 22% changed the indication for conservative treatment (score <5 points) to indication for surgery (score ≥5 points) (53).…”

Burst Fractures in the Thoracolumbar Junction: What Do We Know About Their Treatment?

“…The lack of anterior support was also evaluated by the system proposed by McCormack et al (12,13), grading the degree of vertebral bone injury according to Copyright In the last decades, other CT scan-based characteristics were associated with more severe burst fractures and potential injury of the posterior ligamentous complex, labeling such injuries according to some authors as "unstable" burst fractures. These characteristics are facet joint diastasis, splaying of the spinous process and minor dislocations (8,14,15). Although all these radiological features are potentially associated with a worse outcome, the evidences that indicate surgery are generally weak.…”

“…Magnetic resonance imaging may show signs of severe injuries that would be underestimated in some cases using plain radiographs or CT scan. However, MRI changes must be interpreted together with CT scan, once its use isolated may lead to unnecessary surgeries (1,4,9,14,17,19).…”