MRI and discography in traumatic intervertebral disc lesions

• Published in: European radiology 2006-11, Vol.16 (11), p.2533-2541
• Main Authors: Ghanem, Nadir, Uhl, Markus, Müller, Christoph, Elgeti, Florian, Pache, Gregor, Kotter, Elmar, Markmiller, Max, Langer, Mathias
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Contrast media; Female; Fractures; Hematoma - diagnosis; Hematoma - etiology; Hematoma - surgery; Humans; Injuries; Injury Severity Score; Internal Fixators; Intervertebral Disc - injuries; Intervertebral Disc - pathology; Intervertebral Disc - surgery; Intervertebral discs; Joint and ligament injuries; Ligaments; Ligaments - injuries; Ligaments - pathology; Ligaments - surgery; Lumbar Vertebrae - injuries; Lumbar Vertebrae - pathology; Lumbar Vertebrae - surgery; Magnetic Resonance Imaging; Male; Medical imaging; Middle Aged; Prospective Studies; Skull; Spinal Fractures - complications; Spinal Fractures - diagnosis; Spinal Fractures - pathology; Spinal Fractures - surgery; Spinal Fusion; Spine; Spine (lumbar); Stabilization; Thoracic Vertebrae - injuries; Thoracic Vertebrae - pathology; Thoracic Vertebrae - surgery; Trauma; Treatment Outcome; Vertebrae
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-006-0310-6

In this study we evaluated magnetic resonance imaging (MRI) in trauma patients for assessing traumatised adjacent discs of fractured vertebrae before dorsoventral stabilisation. In a prospective study, MRI of 54 discs was performed with a 1.5-T MRI unit. The preoperative MRI with sagittal T1-W-SE and T2-W-TSE was compared to intraoperative discography, which was carried out on both intervertebral discs adjacent to the fractured vertebrae. Signal alterations, morphological changes in the adjacent discs, fractured vertebrae and associated ligament injuries were evaluated. In 47/54 (87%) of the intervertebral discs, the results of both imaging findings were concordant. The discs adjoining vertebral fractures were normal in 18 cases. Regarding the positive concordant imaging findings, MRI and discography revealed traumatised adjacent cranial and caudal discs in 22 discs. In 7 cases, only the cranial adjacent disc was affected. Moreover, 17 cases of intradiscal bleeding, 13 intraosseous herniations into the fractured vertebrae and 20 anuluar tears were visualised in MRI. Associated ligament injuries were detected in 18 cases. Findings were discordant in eight discs. In six discs, MRI was abnormal, demonstrating signal alterations suggestive of positive imaging findings, whereas discography demonstrated no disc injury. MRI failed to detect disc injury in two discs, whereas discography was positive, showing an irregular intradiscal contrast media distribution. MRI, as a non-invasive method for assessing fractures of the thoraco-lumbar spine, may detect traumatised adjacent intervertebral discs. MRI is superior to intraoperative discography. The performance of MRI of the thoraco-lumbar spine is recommended before dorsoventral stabilisation in trauma patients, as it can reveal additional preoperative information such as fractures, disc and associated ligament injuries.