Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To provide the first meta-analysis of the impact of magnetic resonance imaging (MRI) on thoracolumbar fractures (TLFs) classification and decision-making.

Methods

A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, Cochrane, and Web of Science from inception to June 30, 2023 for studies evaluating the change in TLFs classification and treatment decisions after MRI. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the pooled frequency of change in AO fracture classification or treatment decisions from surgical to conservative or vice versa after MRI.

Results

This meta-analysis included four studies comprising 554 patients. The pooled frequency of change in TLFs classification was 17% (95% CI 9–31%), and treatment decision was 22% (95% CI 11–40%). An upgrade from type A to type B was reported in 15.7% (95% CI 7.2–30.6%), and downgrading type B to type A in 1.2% (95% CI 0.17–8.3%). A change from conservative to surgery recommendation of 17% (95% CI 5.0–43%) was higher than a change from surgery to conservative 2% (95% CI 1–34%).

Conclusions

MRI can significantly change the thoracolumbar classification and decision-making, primarily due to upgrading type A to type B fractures and changing from conservative to surgery, respectively. These findings suggest that MRI could change decision-making sufficiently to justify its use for TLFs. Type A subtypes, indeterminate PLC status, and spine regions might help to predict a change in TLFs’ classification. However, more studies are needed to confirm the association of these variables with changes in treatment decisions to set the indications of MRI in neurologically intact patients with TLFs. An interactive version of our analysis can be accessed from here: https://databoard.shinyapps.io/mri_spine/.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and material

Not applicable.

Code availability

Software application or custom code: Not applicable.

References

  1. Schroeder GD, Harrop JS, Vaccaro AR (2017) Thoracolumbar trauma classification. Neurosurg Clin N Am 28:23–29. https://doi.org/10.1016/j.nec.2016.07.007

    Article  PubMed  Google Scholar 

  2. Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8:817–831. https://doi.org/10.1097/00007632-198311000-00003

    Article  CAS  PubMed  Google Scholar 

  3. Magerl F, Aebi M, Gertzbein SD et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201. https://doi.org/10.1007/BF02221591

    Article  CAS  PubMed  Google Scholar 

  4. Vaccaro AR, Lehman RA, Hurlbert RJ et al (2005) A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 30:2325–2333. https://doi.org/10.1097/01.brs.0000182986.43345.cb

    Article  PubMed  Google Scholar 

  5. Vaccaro AR, Oner C, Kepler CK et al (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 38:2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381

    Article  PubMed  Google Scholar 

  6. Rajasekaran S, Vaccaro AR, Kanna RM et al (2017) The value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries. Eur Spine J 26:1463–1469. https://doi.org/10.1007/s00586-016-4623-0

    Article  PubMed  Google Scholar 

  7. Aly MM, Al-Shoaibi AM, Zahrani A, Al Fattani A (2021) Analysis of the combined computed tomography findings improves the accuracy of computed tomography for detecting posterior ligamentous complex injury of the thoracolumbar spine as defined by magnetic resonance imaging. World Neurosurg. https://doi.org/10.1016/j.wneu.2021.04.106

    Article  PubMed  Google Scholar 

  8. Leferink V, Veldhuis E, Zimmerman K et al (2002) Classificational problems in ligamentary distraction type vertebral fractures: 30% of all B-type fractures are initially unrecognised. Eur Spine J 11:246–250. https://doi.org/10.1007/s00586-001-0366-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Petersilge CA, Pathria MN, Emery SE, Masaryk TJ (1995) Thora columbar burst fractures: evaluation with MR imaging. Radiology 194:49–54

    Article  CAS  PubMed  Google Scholar 

  10. Qureshi S, Dhall SS, Anderson PA et al (2019) Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: radiological evaluation. Clin Neurosurg 84:E28–E31. https://doi.org/10.1093/neuros/nyy373

    Article  Google Scholar 

  11. Pizones J, Izquierdo E, Álvarez P et al (2011) Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment. Eur Spine J 20(Suppl 3):390–396. https://doi.org/10.1007/s00586-011-1913-4

    Article  PubMed  PubMed Central  Google Scholar 

  12. Winklhofer S, Thekkumthala-Sommer M, Schmidt D et al (2013) Magnetic resonance imaging frequently changes classification of acute traumatic thoracolumbar spine injuries. Skeletal Radiol 42:779–786. https://doi.org/10.1007/s00256-012-1551-x

    Article  PubMed  Google Scholar 

  13. Aly MM, Al-Shoaibi AM, Abduraba Ali S et al (2022) How often would MRI change the thoracolumbar fracture classification or decision-making compared to ct alone? Orig Res Glob Spine J. https://doi.org/10.1177/21925682221089579

    Article  Google Scholar 

  14. Durmaz A, İlter MH, Tuzlali H (2021) Is magnetic resonance imaging needed for decision making diagnosis and treatment of thoracic and lumbar vertebral fractures? Eur J Orthop Surg Traumatol. https://doi.org/10.1007/S00590-021-03165-Z

    Article  PubMed  Google Scholar 

  15. Whiting PF, Rutjes AWSS, Westwood ME et al (2011) QUADAS-2: arevised tool for quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536

    Article  PubMed  Google Scholar 

  16. Aly MM, Al-Shoaibi AM, Aljuzair AH et al (2022) GSJ-systematic review a proposal for a standardized imaging algorithm to improve the accuracy and reliability for the diagnosis of thoracolumbar posterior ligamentous complex injury in computed tomography and magnetic resonance imaging. Glob Spine J. https://doi.org/10.1177/21925682221129220

    Article  Google Scholar 

  17. Bossuyt PM, Reitsma JB, Bruns DE et al (2015) STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies. BMJ 351:1–9. https://doi.org/10.1136/bmj.h5527

    Article  Google Scholar 

  18. Javier P, Sánchez-Mariscal F, Zúñiga L, Patricia Álvarez EI (2013) Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine. Spine (Phila Pa 1976) 38:745–751

    Article  Google Scholar 

  19. Aly MM, Elemam R, El-Sharkawi M, Hurlbert JR (2022) Injury of the thoracolumbar posterior ligamentous complex: a bibliometric literature review. World Neurosurg. https://doi.org/10.1016/J.WNEU.2022.01.041

    Article  PubMed  Google Scholar 

  20. Van Middendorp JJ, Patel AA, Schuetz M, Joaquim AF (2013) The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature. Eur Spine J 22:461–474. https://doi.org/10.1007/s00586-012-2602-7

    Article  PubMed  Google Scholar 

  21. Wu CC, Jin HM, Yan YZ et al (2018) Biomechanical role of the thoracolumbar ligaments of the posterior ligamentous complex: a finite element study. World Neurosurg 112:e125–e133. https://doi.org/10.1016/j.wneu.2017.12.171

    Article  PubMed  Google Scholar 

  22. Rosenthal BD, Boody BS, Jenkins TJ et al (2018) Thoracolumbar burst fractures. Clin Spine Surg 31:143–151. https://doi.org/10.1097/BSD.0000000000000634

    Article  PubMed  Google Scholar 

  23. Aly MM, Al-Shoaibi AM, Al-Aithan A et al (2021) Can vertical laminar fracture further discriminate fracture severity between thoracolumbar AO type A3 and A4 fractures? World Neurosurg. https://doi.org/10.1016/J.WNEU.2021.08.035

    Article  PubMed  Google Scholar 

  24. Benedetti PF, Fahr LM, Kuhns LR, Hayman LA (2000) MR imaging findings in spinal ligamentous injury. Am J Roentgenol 175:661–665. https://doi.org/10.2214/ajr.175.3.1750661

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

No specific funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia

    Mohamed M. Aly

  2. Department of Neurosurgery, Mansoura University, Mansoura, Egypt

    Mohamed M. Aly

  3. Faculty of Medicine, Assiut University, Assuit, Egypt

    Youssef Soliman

  4. Broomfield Hospital, Chelmsford, UK

    Rmy A. Elemam

  5. Unidad de Columna, Hospital Universitario La Paz, Madrid, Spain

    Javier Pizones

  6. Department of Neurosurgery, Security Forces Hospital, Riyadh, Saudi Arabia

    Ahmed Alzahrani

  7. Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Sherif Elwatidy

Authors
  1. Mohamed M. Aly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Youssef Soliman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rmy A. Elemam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Javier Pizones
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ahmed Alzahrani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sherif Elwatidy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Contribution: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MA, YS, RE, JP, AZ, and SW. The first draft of the manuscript was written by the first author; all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohamed M. Aly.

Ethics declarations

Conflict of interest

All authors declare that they have no commercial associations that might pose a conflict of interest in relation to the manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aly, M.M., Soliman, Y., Elemam, R.A. et al. How frequently MRI modifies thoracolumbar fractures’ classification or decision-making? A systematic review and meta-analysis. Eur Spine J 33, 1540–1549 (2024). https://doi.org/10.1007/s00586-023-08087-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-08087-4

Keywords

Search

Navigation