Initial disc structural preservation in type A1 and A3 thoracolumbar fractures.
OBJECTIVE
Despite a sizable amount of literature, the optimal management of thoracolumbar fractures remains controversial and many authors assume the existence of disc lesions in Magerl type A fractures. The purpose of the study was to assess the intervertebral discs in these fractures at the time of trauma. The hypothesis was that there was no change in shape and signal intensity of the discs initially.


METHODS
Fifty-one patients diagnosed with 87 types A1 and A3 thoracolumbar fractures were enrolled in a prospective study. MRI analysis involved evaluation of disc signal, height and morphological modifications according to Oner's classification.


RESULTS
No signal intensity modification was identified on MRI. Disc morphology was either normal or altered with creeping of discal tissue in the vertebral endplate depression. Overall, 98% of the discs were either type 1 or type 3. Mean disc height on MRI was 1.03 ± 0.36 initially.


CONCLUSIONS
In this study, MRI showed that no loss of height occurred in discs adjacent to fractured vertebra and that there was no major alteration of the disc in terms of signal intensity and morphology. Therefore, the intervertebral disc should not be removed in Magerl type A fractures.


METHODS
Level IV, therapeutic case series.
Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: philippeloriaut@hotmail.com.
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Loriaut
Service de radiologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
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Mercy
Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
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Moreau
Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
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Sariali
Service de chirurgie orthopédique et de traumatologie, hôpital Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
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Boyer
Service de radiologie, clinique du sport, Bordeaux Mérignac, 2, rue Negrevergne, 33700 Mérignac, France; Service de radiologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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Dallaudière
Service de chirurgie orthopédique et de traumatologie, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
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Pascal-Moussellard
D000328:Adult; D017586:Diskectomy; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016103:Spinal Fractures / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology*; D055815:Young Adult
Intervertebral disc; MRI; Spine injury; Thoracolumbar fracture; Vertebra