Artikel
Routine MRI for decision making in thoracolumbar spine fractures
Das routinemässige MRT für die Entscheidungsfindung bei thorakolumbalen Frakturen
Suche in Medline nach
Autoren
Veröffentlicht: | 30. Mai 2008 |
---|
Gliederung
Text
Objective: A prospective cohort study was performed in patients suffering from spine fractures in the thoracolumbar area detected in X-ray and CT images. In order to discover additional signs of injury, all patients were examined by MRI before therapeutic decisions were made.
Methods: 100 patients (69 male/31 female) suffering from 153 fractures in the area T2 to L4 were included in this study. Exclusion criteria were significant osteoporosis and multiple injuries not allowing an initial MRI exam. In all cases lateral and anteroposterior plain radiographs as well as CT scans of the fracture level were obtained before the MRI examination was performed. The radiological assessment was carried out by experienced spinal surgeons on the basis of a standarized checklist concerning each image modality and the Magerl classification of fractures.
Results: 2 patients had a complete, 7 patients had an incomplete spinal cord injury, and 91 patients had no neurological deficits. Surgical treatment was performed in 77 patients. In 40 cases MRI revealed findings invisible in X-ray and CT. In 10 patients MRI showed up to 3 additional fractures. In 12 patients without any neurological deficits we discovered large epidural hematomas. Furthermore, in 12 patients with impaction fractures and wedge shaped fractures there were severe injuries to the vertebral discs. 4 patients had a spinal stenosis in the lower lumbar spine as well.
Conclusions: Up to now, MRI scans in spinal fractures were only important in cases of spinal cord injuries and in special cases of cervical spine fractures. In injuries of the thoracolumbar spine, however, X-ray in combination with CT scans were considered to be adequate. The presented series revealed different causes for emphasizing the importance of MRI scans for therapeutic decision making. The detection of otherwise invisible damages of the posterior ligament complex, epidural hematomas, disc injuries as well as additional vertebral fractures using MRI imaging closes a diagnostic gap and influences the patients’ treatment.