Indication for Anterior Disc Replacement in Fractures of Thoracic and Lumbar Spine Using Magnetic Resonance Imaging – a Prospective Study

Czech version

Authors: L. Hrabálek ¹; J. Bučil ²; M. Vaverka ¹; M. Houdek ¹; D. Krahulík ¹; O. Kalita ¹
Authors‘ workplace: Neurochirurgická klinika LF UP a FN Olomouc, 2Radiologická klinika LF UP a FN Olomouc ¹
Published in: Cesk Slov Neurol N 2009; 72/105(2): 132-140
Category: Original Paper

Overview

The a uthors made a prospective evalu ati on of all pati ents with a thoracic or lumbar spine injury who were indicated for conservative therapy or for posteri or transpedicular fixati on (TP) surgery in an 18- month peri od. The gro up consisted of 89 pati ents (with average age of 46.04 ye ars), 58 men and 31 women. The follow‑up peri od was 18 to 36 months. The objective of the study was to ascertain, in the first place, the degree of damage to intervertebral discs and vertebral plates with the use of magnetic resonance imaging (MRI), and to evalu ate the influence of the injuri es on the pati ents’ clinical status while monitoring, for a peri od of 18 months, changes in the structure and form of the discs, the plates and the vertebral bodi es, as well as changes in the intensity of the disc signal during MRI. The results showed that pati ents with a type- A fracture (AO classificati on) who underwent a posteri or transpedicular fixati on procedure tended to develop grosser morphological changes, primarily disc and vertebral body height reducti on or even intraspongi o us herni ati on of both the upper and the lower disc into the vertebral body at higher age and with a proven higher degree of injury of the posteri or longitudinal ligament. Within the same 18- month follow‑up peri od, yo unger pati ents tended to have a lower disc signal intensity on STIR- sequence MRI while clinically showing the best functi onal results. The highest degree of disc and plate damage tre ated only with TP fixati on had significantly worse clinical results than those for lower degree damage. As a result, the evidence of a higher degree of disc and plate damage on the initi al MRI has a predictive value and correlates with a po orer clinical status of the pati ent 18 months post‑injury, and may become an important component of the indicati on algorithm, especi ally in considering anteri or disc replacement.

Key words:
injury – spine – intervertebral disc – magnetic resonance imaging – fixation

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