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Aly MM, Bigdon SF, Speigl UJA, Camino-Willhuber G, Baeesa S, Schnake KJ. Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology. BRAIN & SPINE 2024; 4:102787. [PMID: 38590587 PMCID: PMC10999828 DOI: 10.1016/j.bas.2024.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
Introduction A recent meta-analysis showed that only four prior studies have shown that magnetic resonance imaging (MRI) can change the fracture classification in 17% and treatment decisions in 22% of cases. However, previous studies showed a wide methodological variability regarding the study population, the definition of posterior ligamentous complex (PLC) injury, and outcome measures. Research question How can we standardize the reporting of the impact of MRI for neurologically intact patients with thoracolumbar fractures? Material and methods All available literature regarding the impact of MRI on thoracolumbar fracture classification or decision-making were reviewed. Estimating the impact of MRI on the TLFs' classification is an exercise of analyzing the CTs' accuracy for PLC injury against MRI as a ''Gold standard''and should follow standardized checklists such as the Standards for the Reporting of Diagnostic Accuracy Studies. Additionally, specific issues related to TLFs should be addressed. Results A standardized approach for reporting the impact of MRI in neurologically intact TLF patients was proposed. Regarding patient selection, restricting the inclusion of neurologically intact patients with A- and B-injuries is crucial. Image interpretation should be standardized regarding imaging protocol and appropriate criteria for PLC injury. The impact of MRI can be measured by either the rate of change in fracture classification or treatment decisions; the cons and pros of each measure is thoroughly discussed. Discussion and conclusion We proposed a structured methodology for examining the impact of MRI on neurologically intact patients with TLFs, focusing on appropriate patient selection, standardizing image analysis, and clinically relevant outcome measures.
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Affiliation(s)
- Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Sebastian F Bigdon
- Department of Orthopedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich J A Speigl
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | | | - Saleh Baeesa
- Neuroscience department, King Faisal Specialist Hospital, Jeddah, Saudi Arabia
| | - Klaus J Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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Wenjie L, Jiaming Z, Weiyu J. The difference and clinical application of modified thoracolumbar fracture classification scoring system in guiding clinical treatment. J Orthop Surg Res 2023; 18:493. [PMID: 37434179 DOI: 10.1186/s13018-023-03958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the feasibility of the modified thoracolumbar injury classification and severity score system in guiding clinical treatment. METHODS A retrospective study was conducted on a cohort of 120 patients with thoracolumbar fractures who were admitted to the Department of Spinal Surgery at Ningbo Sixth Hospital between December 2019 and June 2021. The study population consisted of 68 males and 52 females, with an average age of 36.7 ± 5.7 years. The severity of the fractures was assessed based on comprehensive scores incorporating fracture morphology, neurological function, posterior ligament complex integrity, and disc injury status. The evaluation was performed using the total score T, which guided the formulation of the clinical treatment strategy. Furthermore, the study compared the treatment options, imaging data, and clinical efficacy between two classification systems. RESULTS The analysis of 120 patients revealed no statistically significant difference in the total score or treatment method between the TLICS system and the modified TLICS system. However, the operation rate for the modified TLICS system (73.3%) was slightly lower compared to the TLICS system (79.2%). All patients were followed up for a mean duration of 19.2 ± 4.6 months, ranging from 11 to 27 months. At the last follow-up, the visual analogue scale score was 1.94 ± 0.52, and the modified Japanese Orthopaedic Association score was 28.8 ± 4.5, indicating a significant improvement compared to the scores obtained prior to treatment. The neurological status exhibited varying degrees of improvement. Notably, the anterior vertebral height ratio was 87.10 ± 7.17%, the sagittal index was 90.35 ± 7.72%, and the Cobb angle was 3.05 ± 0.97 degrees at the last follow-up. All these measurements demonstrated statistically significant differences compared to the values observed prior to treatment (P < 0.05). Additionally, two cases of pedicle screw breakage and seven cases of pedicle screw wear and cutting in the vertebral body were observed at the last follow-up, resulting in varying degrees of low back pain. However, no instances of rod breakage were reported. CONCLUSION The modified TLICS system is a practical tool for the classification and assessment of thoracolumbar fractures. It has guiding significance for clinical treatment, and the operation rate was slightly lower than that of TLICS system.
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Affiliation(s)
- Lu Wenjie
- Ningbo Sixth Hospital, Ningbo, 315000, China
| | - Zhang Jiaming
- Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310000, China
| | - Jiang Weiyu
- Ningbo Sixth Hospital, Ningbo, 315000, China.
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Aly MM, Al-Shoaibi AM, Aljuzair AH, Issa TZ, Vaccaro AR. A Proposal for a Standardized Imaging Algorithm to Improve the Accuracy and Reliability for the Diagnosis of Thoracolumbar Posterior Ligamentous Complex Injury in Computed Tomography and Magnetic Resonance Imaging. Global Spine J 2023; 13:873-896. [PMID: 36222735 DOI: 10.1177/21925682221129220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Literature Review. OBJECTIVE To propose a systematic imaging algorithm for diagnosing posterior ligamentous complex (PLC) injury in computed tomography (CT) and magnetic resonance imaging (MRI) to improve the reliability of PLC assessment. METHODS A systematic review was conducted following PRISMA guidelines. The Scopus database was searched from its inception until July 21, 2022, for studies evaluating CT or MRI assessment of the PLC injury following thoracolumbar trauma. The studies extracted key findings, objectives, injury definitions, and radiographic modalities. RESULTS Twenty-three studies were included in this systematic review, encompassing 2021 patients. Five studies evaluated the accuracy of MRI in detecting thoracolumbar PLC injury using intraoperative findings as a reference. These studies indicate that black stripe discontinuity due to supraspinous or ligamentum flavum rupture is a more specific criterion of PLC injury than high-signal intensity. Thirteen papers evaluated the accuracy or reliability of CT in detecting thoracolumbar PLC injury using MRI or intraoperative findings as a reference. The overall accuracy rate of CT in detecting PLC injury was 68-90%. Two studies evaluate the accuracy of combined CT findings, showing that ≥2 CT findings are associated with a positive predictive value of 88-91 %. Vertebral translation, facet joint malalignment, spinous process fracture, horizontal laminar fracture, and interspinous widening were independent predictors of PLC injury. CONCLUSION We provided a comprehensive imaging algorithm for diagnosing PLC in CT and MRI based on available literature and our experience. The algorithm will potentially improve the accuracy and reliability of PLC assessment, however it needs multicentre prospective validation.
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Affiliation(s)
- Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Abdulbaset M Al-Shoaibi
- Department of Diagnostic Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Ali H Aljuzair
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Tariq Ziad Issa
- Orthopaedic Surgery, 387400Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Orthopaedic Surgery, 387400Rothman Orthopedic Institute, Philadelphia, PA, USA
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Dong S, Li Z, Tang ZR, Zheng Y, Yang H, Zeng Q. Predictors of adverse events after percutaneous pedicle screws fixation in patients with single-segment thoracolumbar burst fractures. BMC Musculoskelet Disord 2022; 23:168. [PMID: 35193550 PMCID: PMC8864915 DOI: 10.1186/s12891-022-05122-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous pedicle screw fixation (PPSF) is the primary approach for single-segment thoracolumbar burst fractures (TLBF). The healing angle at the thoracolumbar junction is one of the most significant criteria for evaluating the efficacy of PPSF. Therefore, the purpose of this study was to analyze the predictors associated with the poor postoperative alignment of the thoracolumbar region from routine variables using a support vector machine (SVM) model. METHODS We retrospectively analyzed patients with TLBF operated at our academic institute between March 1, 2014 and December 31, 2019. Stepwise logistic regression analysis was performed to assess potential statistical differences between all clinical and radiological variables and the adverse events. Based on multivariate logistic results, a series of independent risk factors were fed into the SVM model. Meanwhile, the feature importance of radiologic outcome for each parameter was explored. The predictive performance of the SVM classifier was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy (ACC) and confusion matrices with 10-fold cross-validation, respectively. RESULTS In the recruited 150 TLBFs, unfavorable radiological outcomes were observed in 53 patients (35.33%). The relationship between osteoporosis (p = 0.036), preoperative Cobb angle (p = 0.001), immediate postoperative Cobb angle (p = 0.029), surgically corrected Cobb angle (p = 0.001), intervertebral disc injury (Score 2 p = 0.001, Score 3 p = 0.001), interpedicular distance (IPD) (p = 0.001), vertebral body compression rate (VBCR) (p = 0.010) and adverse events was confirmed by univariate regression. Thereafter, independent risk factors including preoperative Cobb angle, the disc status and IPD and independent protective factors surgical correction angle were identified by multivariable logistic regression. The established SVM classifier demonstrated favorable predictive performance with the best AUC = 0.93, average AUC = 0.88, and average ACC = 0.87. The variables associated with radiological outcomes, in order of correlation strength, were intervertebral disc injury (42%), surgically corrected Cobb angle (25%), preoperative Cobb angle (18%), and IPD (15%). The confusion matrix reveals the classification results of the discriminant analysis. CONCLUSIONS Critical radiographic indicators and surgical purposes were confirmed to be associated with an unfavorable radiographic outcome of TLBF. This SVM model demonstrated good predictive ability for endpoints in terms of adverse events in patients after PPSF surgery.
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Affiliation(s)
- Shengtao Dong
- Department of Spine Surgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Zongyuan Li
- Department of Orthopedics, Mianyang Central Hospital, Mianyang, 621000, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, 430072, China
| | - Yuanyuan Zheng
- Department of Oncology, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Hua Yang
- Department of Otolaryngology, the Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Qiuming Zeng
- Department of Orthopedics, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China.
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Injury of the thoracolumbar posterior ligamentous complex : a bibliometric literature review. World Neurosurg 2022; 161:21-33. [PMID: 35051636 DOI: 10.1016/j.wneu.2022.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This bibliometric review of literature on posterior ligamentous complex (PLC) injury in thoracolumbar (TL) trauma aims to guide future research. METHODS We conducted a keyword-based search from January 2000 to September 2021 using the Scopus database. Relevant publications were analyzed for the year of publication, authorship, publishing journals, institution and country of origin, subject matter, and article type. In addition, content analysis of clinical articles was performed, analyzing for sample size, study design (retrospective vs. prospective), single vs. multicenter, and level of evidence. RESULTS 262 publications have been published in 61 journals by 537 authors, 162 institutions, and 29 countries. Thomas Jefferson University, the University of Calgary, and the University of Toronto have the largest number of publications related to PLC injury. The United States, Canada, and China were the most frequent contributors in terms of the number of publications. Spine was the most prolific and top-cited Journal, while Vaccaro A.R. was the most prolific author. The most cited publication was the Thoracolumbar Injury Classification and Severity Score (TLICS) classification by Vaccaro et al. in 2005. Most of the publications have been case studies, with diagnostic accuracy being the most frequently discussed topic. The sample size for a large portion of the case series was less than 50. The majority of case series were retrospective studies conducted at a single center. CONCLUSION Our review provides an extensive list of the most historically significant spinal imaging articles, acknowledging the key contributions made to the advancement of this research area.
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Is magnetic resonance imaging needed for decision-making diagnosis and treatment of thoracic and lumbar vertebral fractures? by Altuğ Durmaz, November 2021. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1441-1442. [PMID: 35034182 DOI: 10.1007/s00590-021-03184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
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Popp D, Kerschbaum M, Mahr D, Thiedemann C, Ernstberger A, Wiesinger I, Bäumler W, Alt V, Schicho A. Necessity of Immediate MRI Imaging in the Acute Care of Severely Injured Patients. MEDICINA-LITHUANIA 2021; 57:medicina57090982. [PMID: 34577905 PMCID: PMC8470916 DOI: 10.3390/medicina57090982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The standard diagnostic procedure for a patient with a suspected polytrauma injury is computed tomography (CT). In individual cases, however, extended acute imaging using magnetic resonance imaging (MRI) can provide valuable and therapy-relevant information. The aim of our cohort study was to find such cases and to describe their characteristics in order to be able to give possible recommendations for MRI application in acute trauma situations. Materials and Methods: In the study period from 2015-2019, an evaluation of the imaging performed on polytrauma patients was carried out. The specific diagnostic and therapeutic criteria of the MRI group were further defined. Results: In total, 580 patients with an ISS ≥16 (injury severity score) were included in the study. Of these 580 patients, 568 patients received a CT scan and 12 patients an MRI scan as part of the initial diagnostic. Altogether, 66.67% of the MRIs took place outside of regular service hours. The main findings for MRI indications were neurological abnormalities with a focus on myelon injuries. Further MRI examinations were performed to rule out vascular injuries. All in all, 58.3% of the MRIs performed resulted in modified therapeutic strategies afterward. Conclusions: MRI in the context of acute diagnostic of a severely injured patient will likely remain reserved for special indications in the future. However, maximum care hospitals with a high flow of severely injured patients should provide 24/7 MR imaging to ensure the best possible care, especially in neurological and blunt vascular injuries.
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Affiliation(s)
- Daniel Popp
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (D.M.); (C.T.); (V.A.)
- Correspondence: ; Tel.: +49-944-6805; Fax: +49-944-6806
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (D.M.); (C.T.); (V.A.)
| | - Daniel Mahr
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (D.M.); (C.T.); (V.A.)
| | - Claudius Thiedemann
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (D.M.); (C.T.); (V.A.)
| | | | - Isabel Wiesinger
- Institute of Neuroradiology, Medbo Bezirksklinikum Regensburg, 93053 Regensburg, Germany;
| | - Wolf Bäumler
- Department of Radiology, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.B.); (A.S.)
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany; (M.K.); (D.M.); (C.T.); (V.A.)
| | - Andreas Schicho
- Department of Radiology, University Medical Centre Regensburg, 93053 Regensburg, Germany; (W.B.); (A.S.)
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Nudelman B, Mittal A, Rosinski A, Zaborovskii N, Wu S, Kondrashov D. Whole-Spine Magnetic Resonance Imaging: A Review of Suggested Indications. JBJS Rev 2021; 9:01874474-202107000-00004. [PMID: 34257232 DOI: 10.2106/jbjs.rvw.20.00267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The spinal column has a propensity for lesions to manifest in a multifocal manner, and identification of the lesions can be difficult. » When used to image the spine, magnetic resonance imaging (MRI) most accurately identifies the presence and location of lesions, guiding the treatment plan and preventing potentially devastating complications that are known to be associated with unidentified lesions. » Certain conditions clearly warrant evaluation with whole-spine MRI, whereas the use of whole-spine MRI with other conditions is more controversial. » We suggest whole-spine MRI when evaluating and treating any spinal infection, lumbar stenosis with upper motor neuron signs, ankylosing disorders of the spine with concern for fracture, congenital scoliosis undergoing surgical correction, and metastatic spinal tumors. » Use of whole-spine MRI in patients with idiopathic scoliosis and acute spinal trauma remains controversial.
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Affiliation(s)
- Brandon Nudelman
- San Francisco Orthopaedic Residency Program, San Francisco, California
| | - Ashish Mittal
- San Francisco Orthopaedic Residency Program, San Francisco, California
| | | | - Nikita Zaborovskii
- Spine Surgery and Oncology, R.R. Vreden Russian Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia
| | - Samuel Wu
- San Francisco Orthopaedic Residency Program, San Francisco, California
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Philipp LR, Leibold A, Mahtabfar A, Montenegro TS, Gonzalez GA, Harrop JS. Achieving Value in Spine Surgery: 10 Major Cost Contributors. Global Spine J 2021; 11:14S-22S. [PMID: 33890804 PMCID: PMC8076814 DOI: 10.1177/2192568220971288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVES The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused-often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement. METHODS We present a narrative review of the literature regarding 10 features in spine surgery which are characterized by substantial disproportionate costs and minimal-if any-clear benefit. Discussion items were generated from a service-wide poll; topics mentioned with great frequency or emphasis were considered. Items are not listed in hierarchical order, nor is the list comprehensive. RESULTS We describe the cost and clinical data for the following 10 items: Over-referral, Over-imaging & Overdiagnosis; Advanced Imaging for Low Back Pain; Advanced imaging for C-Spine Clearance; Advanced Imaging for Other Spinal Trauma; Neuromonitoring for Cervical Spine; Neuromonitoring for Lumbar Spine/Single-Level Surgery; Bracing & Spinal Orthotics; Biologics; Robotic Assistance; Unnecessary perioperative testing. CONCLUSIONS In the pursuit of value in spine surgery we must define what quality is, and what costs we are willing to pay for each theoretical unit of quality. We illustrate 10 areas for future research and quality improvement initiatives, which are at present overpriced and underbeneficial.
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Affiliation(s)
- Lucas R. Philipp
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA,Lucas R. Philipp, Thomas Jefferson University, 909 Walnut St., 3 rd Floor, Department of Neurosurgery, Philadelphia, PA 19107, USA.
| | - Adam Leibold
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aria Mahtabfar
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thiago S. Montenegro
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Glenn A. Gonzalez
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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von der Höh NH, Henkelmann J, Jarvers JS, Spiegl UJA, Voelker A, Josten C, Heyde CE. Magnetic resonance tomography for the early detection of occult fractures of the spinal column in patients with ankylosing spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:870-878. [DOI: 10.1007/s00586-020-06309-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 10/29/2019] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
The purpose of this study was to determine the extent to which magnetic resonance imaging (MRI) performed in patients with ankylosing spondylitis (AS) after low- and no-energy trauma leads to an improved diagnosis and, as a result, to a change in the therapeutic strategy.
Methods
All patients with AS, who underwent surgery after minor traumas (low-energy traumas, LETs) and patients without trauma history (NET: no-energy trauma), were retrospectively analysed. The diagnostic and planned surgical procedure was examined initially and again after total spine MRI in patients with persistent and/or new complaints.
Results
One hundred and thirty-six patients with AS after trauma were surgically treated. A total of 92 patients with LETs and 12 patients with NETs were included. After initial diagnostics (CT and X-ray) were performed in 15.4% of the patients with LET or NET (n = 16), we found occult fractures on MRI scans. In ten of these patients (6 LET, 4 NET) in which a previous decision was made to follow conservative therapy, no fracture indication was found on CT or X-ray. Two fracture heights were observed in six patients who experienced LET. However, on X-ray and CT, the fractures were only visible at one height. All fractures were treated surgically with stabilization and decompression if indicated.
Conclusion
Considering the high percentage of our patient population with occult fractures, we recommend supplementing the basic diagnostic procedures with an MRI of the entire spinal column in patients with painful spinal column findings after minor trauma and for those with persistent pain without trauma.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.
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Grassner L, Wutte C, Zimmermann G, Grillhösl A, Schmid K, Weiβ T, Maier W, Hauck S, Hollerith T, Vogel M, Bierschneider M, Vastmans J, Thomé C, Gonschorek O, Strowitzki M. Influence of Preoperative Magnetic Resonance Imaging on Surgical Decision Making for Patients with Acute Traumatic Cervical Spinal Cord Injury: A Survey Among Experienced Spine Surgeons. World Neurosurg 2019; 131:e586-e592. [PMID: 31404692 DOI: 10.1016/j.wneu.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Early decompression after acute spinal cord injury (SCI) is recommended. Acute care is crucial, but optimal management is unclear. The aim of this study was to investigate the role of preoperative magnetic resonance imaging (MRI) in addition to computed tomography (CT) in surgical decision making for acute cervical SCI. METHODS All patients with cervical SCI between 2008 and 2016 who had preoperative CT and MRI (n = 63) at the Trauma Center Murnau, Germany, were included. We administered a survey to 10 experienced spine surgeons (5 neurosurgeons, 5 trauma surgeons) regarding the surgical management. First, the surgeons were shown clinical information and CT scans. Two months later, the survey was repeated with additional MRI. Corresponding percentages of change and agreement were obtained for each rater and survey item. Finally, results from both parts of the survey were compared with the definitive treatment option (i.e., real-world decision). RESULTS MRI modified surgical timing in a median of 41% of patients (interquartile range 38%-56%). In almost every fifth patient (17%), no surgery would have been indicated with CT alone. The advocated surgical approach was changed in almost half of patients (median 48%, interquartile range 33%-49%). Surgically addressed levels were changed in a median of 57% of patients (interquartile range 56%-60%). MRI led to higher agreement with the real-world decision concerning addressed levels (median 35% vs. 73%), timing (median 51% vs. 57%), and approach (median 44% vs. 65%). CONCLUSIONS Preoperative MRI influenced surgical decision making substantially in our cohort and has become a new standard for patients with cervical SCI in our institution if medically possible.
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Affiliation(s)
- Lukas Grassner
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany; Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany; Institute for Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
| | - Christof Wutte
- Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany
| | - Georg Zimmermann
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Christian Doppler Medical Center and Center for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Grillhösl
- Department of Neuroradiology, BG Trauma Center Murnau, Murnau, Germany
| | - Katharina Schmid
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
| | - Thomas Weiβ
- Department of Spine Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Walter Maier
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
| | - Stefan Hauck
- Department of Spine Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Tobias Hollerith
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
| | - Matthias Vogel
- Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany
| | | | - Jan Vastmans
- Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Oliver Gonschorek
- Department of Spine Surgery, BG Trauma Center Murnau, Murnau, Germany
| | - Martin Strowitzki
- Department of Neurosurgery, BG Trauma Center Murnau, Murnau, Germany
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