Management of thoracolumbar spine trauma: An overview.

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Abstract

Conflict of interest statement: Conflict of Interest: None. 14. Eur Spine J. 2024 Apr;33(4):1540-1549. doi: 10.1007/s00586-023-08087-4. Epub 2024 Feb 12. How frequently MRI modifies thoracolumbar fractures' classification or decision-making? A systematic review and meta-analysis. Aly MM(1)(2), Soliman Y(3), Elemam RA(4), Pizones J(5), Alzahrani A(6), Elwatidy S(7). Author information: (1)Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia. drmoali26@gmail.com. (2)Department of Neurosurgery, Mansoura University, Mansoura, Egypt. drmoali26@gmail.com. (3)Faculty of Medicine, Assiut University, Assuit, Egypt. (4)Broomfield Hospital, Chelmsford, UK. (5)Unidad de Columna, Hospital Universitario La Paz, Madrid, Spain. (6)Department of Neurosurgery, Security Forces Hospital, Riyadh, Saudi Arabia. (7)Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. PURPOSE: To provide the first meta-analysis of the impact of magnetic resonance imaging (MRI) on thoracolumbar fractures (TLFs) classification and decision-making. METHODS: A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, Cochrane, and Web of Science from inception to June 30, 2023 for studies evaluating the change in TLFs classification and treatment decisions after MRI. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the pooled frequency of change in AO fracture classification or treatment decisions from surgical to conservative or vice versa after MRI. RESULTS: This meta-analysis included four studies comprising 554 patients. The pooled frequency of change in TLFs classification was 17% (95% CI 9-31%), and treatment decision was 22% (95% CI 11-40%). An upgrade from type A to type B was reported in 15.7% (95% CI 7.2-30.6%), and downgrading type B to type A in 1.2% (95% CI 0.17-8.3%). A change from conservative to surgery recommendation of 17% (95% CI 5.0-43%) was higher than a change from surgery to conservative 2% (95% CI 1-34%). CONCLUSIONS: MRI can significantly change the thoracolumbar classification and decision-making, primarily due to upgrading type A to type B fractures and changing from conservative to surgery, respectively. These findings suggest that MRI could change decision-making sufficiently to justify its use for TLFs. Type A subtypes, indeterminate PLC status, and spine regions might help to predict a change in TLFs' classification. However, more studies are needed to confirm the association of these variables with changes in treatment decisions to set the indications of MRI in neurologically intact patients with TLFs. An interactive version of our analysis can be accessed from here: https://databoard.shinyapps.io/mri_spine/ . © 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. DOI: 10.1007/s00586-023-08087-4