gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Article

Send article

Routine MRI for decision making in thoracolumbar spine fractures

Das routinemässige MRT für die Entscheidungsfindung bei thorakolumbalen Frakturen

Meeting Abstract

Search Medline for

  • corresponding author K. Ebmeier - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • C. Gerhardt - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • R. Reichart - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • R. Kalff - Klinik für Neurochirurgie, Universitätsklinikum Jena

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocSO.03.12

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc023.shtml

Published: May 30, 2008

© 2008 Ebmeier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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.