Does Magnetic Resonance Imaging Predict Neurological Deficit in Patients with Traumatic Lower Lumbar Fractures?

IF 2.3 Q2 ORTHOPEDICS
Asian Spine Journal Pub Date : 2024-04-01 Epub Date: 2024-03-08 DOI:10.31616/asj.2023.0311
Karthik Ramachandran, R Dinesh Iyer, Prashasth Belludi Suresh, Ajoy Prasad Shetty, Puspha Bhari Thippeswamy, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran
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引用次数: 0

Abstract

Study design: A retrospective cohort study.

Purpose: This study aimed to understand the role of magnetic resonance imaging (MRI) in predicting neurological deficits in traumatic lower lumbar fractures (LLFs; L3-L5).

Overview of literature: Despite studies on the radiological risk factors for neurological deficits in thoracolumbar fractures, very few have focused on LLFs. Moreover, the potential utility of MRI in LLFs has not been evaluated.

Methods: In total, 108 patients who underwent surgery for traumatic LLFs between January 2010 and January 2020 were reviewed to obtain their demographic details, injury level, and neurology status at the time of presentation (American Spinal Injury Association [ASIA] grade). Preoperative computed tomography scans were used to measure parameters such as anterior vertebral body height, posterior vertebral body height, loss of vertebral body height, local kyphosis, retropulsion of fracture fragment, interpedicular distance, canal compromise, sagittal transverse ratio, and presence of vertical lamina fracture. MRI was used to measure the canal encroachment ratio (CER), cross-sectional area of the thecal sac (CSAT), and presence of an epidural hematoma.

Results: Of the 108 patients, 9 (8.3%) had ASIA A, 4 (3.7%) had ASIA B, 17 (15.7%) had ASIA C, 21 (19.4%) had ASIA D, and 57 (52.9%) had ASIA E neurology upon admission. The Thoracolumbar Injury Classification and Severity score (p =0.000), CER (p =0.050), and CSAT (p =0.019) were found to be independently associated with neurological deficits on the multivariate analysis. The receiver operating characteristic curves showed that only CER (area under the curve [AUC], 0.926; 95% confidence interval [CI], 0.860-0.968) and CSAT (AUC, 0.963; 95% CI, 0.908-0.990) had good discriminatory ability, with the optimal cutoff of 50% and 65.3 mm2, respectively.

Conclusions: Based on the results, the optimal cutoff values of CER >50% and CSAT >65.3 mm2 can predict the incidence of neurological deficits in LLFs.

磁共振成像能否预测创伤性下腰椎骨折患者的神经功能缺损?
研究设计目的:本研究旨在了解磁共振成像(MRI)在预测创伤性下腰椎骨折(LLFs;L3-L5)神经功能缺损中的作用:尽管对胸腰椎骨折神经功能缺损的放射学风险因素进行了研究,但关注 LLF 的研究却寥寥无几。此外,核磁共振成像在 LLF 中的潜在作用也尚未得到评估:方法:我们对 2010 年 1 月至 2020 年 1 月期间因外伤性 LLF 接受手术的 108 例患者进行了回顾性研究,以了解他们的详细人口统计学资料、受伤程度以及就诊时的神经学状况(美国脊柱损伤协会 [ASIA] 分级)。术前计算机断层扫描用于测量椎体前方高度、椎体后方高度、椎体高度缺失、局部椎体后凸、骨折片后移、关节间距离、椎管损伤、矢状横比和垂直薄板骨折等参数。核磁共振成像用于测量椎管侵蚀比(CER)、椎囊横截面积(CSAT)和是否存在硬膜外血肿:结果:108 名患者中,9 人(8.3%)入院时患有 ASIA A,4 人(3.7%)患有 ASIA B,17 人(15.7%)患有 ASIA C,21 人(19.4%)患有 ASIA D,57 人(52.9%)患有 ASIA E。多变量分析发现,胸腰椎损伤分类和严重程度评分(p =0.000)、CER(p =0.050)和 CSAT(p =0.019)与神经功能缺损独立相关。接受者操作特征曲线显示,只有 CER(曲线下面积 [AUC],0.926;95% 置信区间 [CI],0.860-0.968)和 CSAT(AUC,0.963;95% CI,0.908-0.990)具有良好的鉴别能力,其最佳临界值分别为 50%和 65.3 mm2:根据研究结果,CER >50%和CSAT >65.3 mm2的最佳临界值可以预测LLF神经功能缺损的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Asian Spine Journal
Asian Spine Journal ORTHOPEDICS-
CiteScore
5.10
自引率
4.30%
发文量
108
审稿时长
24 weeks
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