title: Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment.
abstract: BACKGROUND
  The role of magnetic resonance imaging (MRI) has recently been enhanced in the diagnosis of thoracolumbar fractures due to its ability to examine soft tissue injury.
  
  
  METHODS
  We conducted a prospective study to analyze the usefulness of MRI in fracture diagnosis and its influence on treatment decision making. Thirty-three patients were enrolled after suffering an acute traumatic thoracolumbar fracture. Osteoporotic or pathologic fractures were excluded. Fractures were initially classified using X-ray and CT scan following the AO classification. Afterward, a selective MRI protocol was performed with T1 and T2-weighted FS/STIR sequences. Subsequently, fractures were classified according to the TLICS system and reclassified following the AO system. Analysis was performed before and after MRI, focusing on: diagnostic changes, occult fractures and differences in treatment decision making.
  
  
  RESULTS
  Thirty patients (15 males, 15 females) with an average age of 39.9 years were studied. Forty-one fractures were initially diagnosed using plain X-rays and CT scans, while MRI diagnosed 50 fractures and 9 vertebral contusions. MRI modified our diagnosis in 40% of our patients (discovering 18 occult injuries), the classification of fracture pattern in 24% of the fractures (mostly upgrading type A to type B patterns) and the therapeutic management in 16% of our patients.
  
  
  CONCLUSIONS
  MRI seems to be a useful tool in the evaluation of thoracolumbar acute fractures, as it allows a better visualization of the posterior complex integrity and of the levels involved, offering additional information compared to traditional diagnostic tools.
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Madrid, Spain. javier.pizones@wanadoo.es
authors.forename: Javier
authors.initials: J
authors.lastname: Pizones
authors.forename: Enrique
authors.initials: E
authors.lastname: Izquierdo
authors.forename: Patricia
authors.initials: P
authors.lastname: Alvarez
authors.forename: Felisa
authors.initials: F
authors.lastname: Sánchez-Mariscal
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zúñiga
authors.forename: Paloma
authors.initials: P
authors.lastname: Chimeno
authors.forename: Ester
authors.initials: E
authors.lastname: Benza
authors.forename: Ernesto
authors.initials: E
authors.lastname: Castillo
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D015203:Reproducibility of Results; D017695:Soft Tissue Injuries / Q000175:diagnosis; D016103:Spinal Fractures / Q000145:classification* / Q000175:diagnosis* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000293:injuries*; D055815:Young Adult