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How frequently MRI modifies thoracolumbar fractures' classification or decision-making? A systematic review and
Mohamed M Aly1,2, Youssef Soliman3, Rmy A Elemam4
1Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia. drmoali26@gmail.com.
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/ .
Insights
Magnetic resonance imaging (MRI) significantly alters thoracolumbar fracture (TLF) classification and treatment decisions, often leading to surgical recommendations. This meta-analysis confirms MRI
Area of Science:
- Orthopedic surgery and radiology
- Spinal trauma imaging and classification
Background:
- Thoracolumbar fractures (TLFs) require accurate classification for optimal treatment.
- The role of magnetic resonance imaging (MRI) in refining TLF management is under investigation.
Approach:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched major databases (PubMed, Scopus, Cochrane, Web of Science) up to June 2023.
- Analyzed four studies (554 patients) on changes in TLF classification and treatment post-MRI.
Key Points:
- Overall, 17% of TLF classifications and 22% of treatment decisions changed after MRI.
- MRI frequently upgraded AO type A to type B fractures (15.7%) and shifted conservative to surgical recommendations (17%).
- A minority of cases showed downgrading of fracture types or treatment plans.
Conclusions:
- MRI significantly impacts TLF classification and treatment decisions, supporting its clinical utility.
- Findings suggest MRI may be particularly valuable for refining management of type A fractures and conservative cases.
- Further research is needed to identify predictors for MRI-induced changes in neurologically intact patients.
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