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Is magnetic resonance imaging needed for decision making diagnosis and treatment of thoracic and lumbar vertebral fractures?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

A Correction to this article was published on 25 January 2022

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Abstract

Purpose

The radiological examination including plain radiography, CT and MRI are critical to assess the severity of the instability, to diagnose the fracture type and to select the appropriate treatment strategy for the thoracic and lumbar vertebral fractures. The aim of this prospective observational study was to investigate the effect of magnetic resonance imaging (MRI) on decision making for the diagnosis and treatment of acute thoracic and lumbar vertebral fractures.

Methods

Consecutive 180 patients with acute thoracic and/or lumbar vertebral fractures were included in the study. The fracture pattern was evaluated by using initial radiographs, computed tomography (CT) and MRI within 24 h of trauma. Fractures were classified according to AO classification before and after MRI. TLICS classification was also used to decide treatment plan. MRI findings were compared to surgical findings in the surgically treated patients.

Results

A significant moderate agreement was found between Xray + CT and post-MRI classifications for all fracture types (Kappa = 0.511; p < 0.001). In 101 patients with new findings on MRI, a significant moderate correlation was observed between Xray + CT and post-MRI classifications in the fracture re-classification (Kappa = 0.441, p < 0.001). There was a significant change in the treatment plan of patients with new findings on MRI according to Xray + CT (p < 0.0001). After MRI evaluation, the treatment plan changed in favor of surgery in 33.9% of patients who were scheduled for conservative treatment according to Xray + CT (p < 0.0001).

Conclusion

Since MRI assessment of acute thoracic and/or lumbar injuries has led to a remarkable treatment change decision that confirms intraoperative findings of the patients who were decided to undergo surgery, MRI should be obtained in thoracic and lumbar vertebral fractures, regardless of the CT and plain radiographic findings.

Level of evidence

Level II, prospective observational study.

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Acknowledgements

The study entitled ‘Is magnetic resonance imaging needed for decision making diagnosis and treatment of thoracic and lumbar vertebral fractures?’ was performed in Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey after the approval of the local ethics committee (IRB decision number: 2017/60 and protocol code: 2017-04-10).

Funding

No fund was declared.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, Bakırkö, 34147, Istanbul, Turkey

    Altuğ Durmaz

  2. Department of Orthopedics and Traumatology, Letoon Hospital, Pazaryeri St., Küçükçoban Ave, Number 22, 48300, Fethiye/Muğla, Turkey

    Mehmet Hakan İlter

  3. Department of Radiology, Wexham Park Hospital, Wexham Street, Slough Berkshire, London, UK

    Hatice Tuzlali

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All the authors have approved the final contents of the submission and been actively involved in the planning and in the enactment of the study.

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Correspondence to Altuğ Durmaz.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of HELSINKI and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Durmaz, A., İlter, M.H. & Tuzlali, H. Is magnetic resonance imaging needed for decision making diagnosis and treatment of thoracic and lumbar vertebral fractures?. Eur J Orthop Surg Traumatol 33, 107–115 (2023). https://doi.org/10.1007/s00590-021-03165-z

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