Multilevel non-contiguous spinal injuries: incidence and patterns based on whole spine MRI

Area of Science:

• Spinal imaging
• Trauma radiology
• Orthopedic surgery

Background:

• Multi-level non-contiguous spinal injuries are common, with variable incidence based on imaging modality.
• Delayed diagnosis of these injuries can lead to significant pain, deformity, and neurological deficits.
• The diagnostic efficacy of whole spine MRI for asymptomatic vertebral fractures remains unclear.

Purpose of the Study:

• To evaluate the incidence of multi-level non-contiguous spinal injuries.
• To identify common patterns of these injuries.
• To assess the role of whole spine MRI in detecting missed secondary injuries.

Main Methods:

• Retrospective evaluation of consecutive spinal injury patients (2011-2013).
• Analysis of clinical and radiographic records, including demographics, injury mechanisms, and neurological status.
• Comparison of standard radiographs with whole spine MRI findings for multi-level injuries.

Main Results:

• 95 out of 484 patients (19.62%) had multi-level injuries, with 86 (17.76%) having non-contiguous injuries.
• Five distinct patterns of non-contiguous injuries were identified, with cervical and thoracic levels being most frequent.
• Whole spine MRI detected 24 (28.6%) missed secondary injuries, including 5 that were unstable.

Conclusions:

• Whole spine MRI reveals a 17.76% incidence of multi-level non-contiguous spine injuries.
• Cervical and thoracic level injuries represent the most common pattern.
• Missed secondary injuries, including unstable ones, highlight the importance of comprehensive spinal imaging.