Multilevel non-contiguous spinal injuries: incidence and patterns based on whole spine MRI.
OBJECTIVE
Multi-level non-contiguous spinal injuries are not uncommon and their incidence varies from 1.6 to 77% depending on the type of imaging modality used. Delayed diagnosis and missed spinal injuries in non-contiguous spine fractures have been frequently described which can result in significant pain, deformity and neurological deficit. The efficacy of whole spine MRI in detecting asymptomatic significant vertebral fractures is not known.


METHODS
Consecutive spinal injury patients treated between 2011 and 2013 were retrospectively evaluated based on clinical and radiographic records. Patients' demographics, mode of injury, presence of associated injuries, clinical symptoms and the presence of neurological deficit were studied. Radiographs of the fractured region and whole spine MRI were evaluated for the presence of multi-level injuries.


RESULTS
Among 484 patients, 95 (19.62%) patients had multilevel injuries including 86 (17.76%) with non-contiguous injuries. Five common patterns of non-contiguous spinal injuries were observed. Pattern I: cervical and thoracic--29.1%, Pattern II: thoracolumbar and lumbosacral--22.1%, Pattern III: thoracic and thoracolumbar--12.8 %, Pattern IV: cervical and thoracolumbar--9.1% and Pattern V: lumbosacral and associated injuries--9.0 %. The incidence of intra-regional non-contiguous injuries was 17.4%. Whole spine MRI scan detected 24 (28.6%) missed secondary injuries of which 5 were unstable.


CONCLUSIONS
The incidence of multilevel non-contiguous spine injury using whole spine MRI imaging is 17.76%. Five different patterns of multi-level non-contiguous injuries were found with the most common pattern being the cervical and thoracic level injuries. The incidence of unstable injuries can be as high as 21% of missed secondary injuries.
Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India.
Rishi Mugesh
RM
Kanna
Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India.
Chandrasekar V
CV
Gaike
Department of Radiology, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India.
Anupama
A
Mahesh
Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India.
Ajoy Prasad
AP
Shetty
Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India. sr@gangahospital.com.
S
S
Rajasekaran
D000058:Accidental Falls; D000063:Accidents, Traffic; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology*; D010146:Pain; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013124:Spinal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology*
Multi-level; Non-contiguous; Spinal trauma; Whole spine MRI