J Korean Soc Spine Surg.  2008 Jun;15(2):67-72. 10.4184/jkss.2008.15.2.67.

Clinical Importance of MRI in Thoracolumbar Spinal Fracture

Affiliations
  • 1Department of Orthopedic Surgery, Ajou University School of Medicine, In-Choen, Korea. bone@ajou.ac.kr
  • 2Department of Orthopedic Surgery, Sung-Min Hospital, In-Choen, Korea.

Abstract

STUDY DESIGN: Retrospective radiologic assessment
OBJECTIVES
To assess the clinical importance of MRI for the diagnosis of posterior spinal ligament complex injuries in thoracolumbar fractures. SUMMARY OF LITERATURE REVIEW: Evaluation of spinal instability is important in thoracolumbar fractures. When simple radiography and CT alone are performed, spinal instability may be missed, especially that involving the posterior spinal ligament complex.
MATERIALS AND METHODS
Eighty-seven patients who were evaluated using simple radiography, computed tomography (CT), and magnetic resonance imaging (MRI) between March 1994 and March 2003 were included in the study. The local kyphotic angle was measured on lateral radiography, and it was then compared to the fracture pattern on MRI. Statistical analysis was performed using ANOVA.
RESULTS
There was no correlation between the local kyphotic angle on radiography and fracture involvement on MRI (p=0.106). In 41 patients who were found to have involvement of the anterior column on CT, 25 had anterior column involvement, 4 had middle column involvement, and 12 had posterior column involvement on MRI. In 36 patients who were found to have involvement of the middle column on CT, 17 had involvement of the middle column and 19 had involvement of the posterior column on MRI. The fractures of the ten patients who were found to have posterior column involvement on CT were all seen on MRI. The coincidence of fracture patterns between CT and MRI, which was evaluated using Cohen's Kappa analysis, was 0.434. The sensitivity of CT compared with MRI was 0.741 in the middle column and 0.243 in the posterior column.
CONCLUSIONS
Many thoracolumbar fractures are missed on both simple radiography and CT. MRI is essential for accurate diagnosis of posterior spinal ligament complex injuries, especially when there is involvement above the middle column, or when canal encroachment is seen on CT.

Keyword

Thoracolumbar fracture; Posterior ligament complex; CT; MRI
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