[Contribution of MRI to the thoracolumbar spine injuries diagnostics and therapy]

Abstract

Aim: The aim of this study was to assess correlation between the degree of severity of the intervertebral disc injury and the vertebral enoplate injury, evaluated based on MRI, and the resulting final clinical condition and radiological findings.

Material and methodology: The authors performed a prospective analysis of patients with thoracolumbar fractures type A1 or A3, without injuries to the nervous system. The study group included 73 subjects (the mean age was 45.52 years), 44 males and 29 females. The type A1 fracture group including 31 patients received conservative treatment and the type A3 fracture group including 42 subjects underwent surgery with posterior transpedicular (TP) fixation. After their injury, the patients were examined using plain x-rays, CT and MRI. At month 18 of their follow up, a control MRI examination was performed to assess spinal kyphotization, the spinal body height decrease and the clinical outcomes.

Results: The data underwent statistical evaluation. The conservative treatment group showed no statistically significant correlation between the severity of the intervertebral disc and vertebral enoplate trauma and the resulting final clinical outcome or radiological findings, however, the conservative treatment of the type A1 fractures failed in 9.3% of the subjects. This was due to the disc trauma and its consecutive replacement resulted in improvement of the clinical condition. Posterior TP fixation in the type A3 fractures did not prevent statistically significant higher rates of kyphotization and reduced weight- bearing tolerance in patients with more severe disc and vertebral enoplate traumas (grade 3 or 4), compared to patients with less severe traumas (grade 2).

Conclusion: Posttraumatic assessment of the disc and vertebral enoplate trauma severity using MRI is of significance for predicting the fracture healing prognosis, as well as the final clinical outcome of the procedure.