Abstract
Introduction
Although imaging has a major role in evaluation and management of thoracolumbar spinal trauma, the exact role of CT and MRI in addition to radiographs for fracture classification and management is unclear. We conducted an online survey base study to evaluate the added value of computed tomography (CT) and magnetic resonance imaging (MRI) in classification, evaluation of stability and management of thoracolumbar injuries.
Methods
Spine surgeons (n = 41) from around the world classified 30 thoracolumbar fractures. The cases were presented in a three step approach: first plain radiographs, followed by CT and MRI images. Surgeons were asked to classify according to the AO Spine Classification System, evaluate fracture stability and choose management.
Results
Surgeons correctly classified 43.4% of fractures with plain radiographs alone; after additionally evaluating CT and MRI images, this percentage increased by further 18.2% and 2.2% respectively. Instability was diagnosed in 68.5% cases with plain radiographs and this percentage increased to 79.3% after CT (p < .0001) but did not increase significantly after MRI. AO Type A fractures were identified in 51.7% of fractures with radiographs while the number of type B fractures increased after CT and MRI. The number of type C fractures diagnosed was constant across the three steps. Agreement between radiographs and CT was fair for A-type (k=0.31), poor for B-type (k=0.19), but it was excellent between CT and MRI (k > 0.87). CT and MRI had similar sensitivity in identifying fracture sub types except that MRI had a higher sensitivity (56.5%) for B2 fractures (p < 0.001).
Conclusion
For accurate classification, radiographs alone were insufficient except for C type injuries. CT is mandatory for accurately classifying thoracolumbar fractures. Though MRI did confer a modest gain in sensitivity in B2 injuries, the study does not support the need for routine MRI in patients without spinal cord injury for classification, assessing instability or need for surgery.