Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Neurosurgery. 2019 Jan 1;84(1):E28-E31. doi: 10.1093/neuros/nyy373.
Radiological evaluation of traumatic thoracolumbar fractures is used to classify the injury and determine the optimal treatment plan. Currently, there remains a lack of consensus regarding appropriate radiological protocol. Most clinicians use a combination of plain radiographs, 3-dimensional computed tomography with reconstructions, and magnetic resonance imaging (MRI).
To determine, through evidence-based guidelines review: (1) whether the use of MRI to identify ligamentous integrity predicted the need for surgical intervention; and (2) if there are any radiological findings that can assist in predicting clinical outcomes.
A systematic review of the literature was performed using the National Library of Medicine/PubMed database and the Cochrane Library for studies relevant to thoracolumbar trauma. Clinical studies specifically addressing the radiological evaluation of thoracolumbar spine trauma were selected for review.
Two of 2278 studies met inclusion criteria for review. One retrospective review (Level III) and 1 prospective cohort (Level III) provided evidence that the addition of an MRI scan in acute thoracic and thoracolumbar trauma can predict the need for surgical intervention. There was insufficient evidence that MRI can help predict clinical outcomes in patients with acute traumatic thoracic and thoracolumbar spine injuries.
This evidence-based guideline provides a Grade B recommendation that radiological findings in patients with acute thoracic or thoracolumbar spine trauma can predict the need for surgical intervention. This evidence-based guideline provides a grade insufficient recommendation that there is insufficient evidence to determine if radiographic findings can assist in predicting clinical outcomes in patients with acute thoracic and thoracolumbar spine injuries.
QUESTION 1: Are there radiographic findings in patients with traumatic thoracolumbar fractures that can predict the need for surgical intervention?
RECOMMENDATION 1: Because MRI has been shown to influence the management of up to 25% of patients with thoracolumbar fractures, providers may use MRI to assess posterior ligamentous complex integrity, when determining the need for surgery. Strength of Recommendation: Grade B.
QUESTION 2: Are there radiographic findings in patients with traumatic thoracolumbar fractures that can assist in predicting clinical outcomes?
RECOMMENDATION 2: Due to a paucity of published studies, there is insufficient evidence that radiographic findings can be used as predictors of clinical outcomes in thoracolumbar fractures. Strength of Recommendation: Grade Insufficient The full version of the guideline can be reviewed at: https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_3.
创伤性胸腰椎骨折的影像学评估用于对损伤进行分类，并确定最佳治疗方案。目前，对于合适的影像学方案仍缺乏共识。大多数临床医生使用 X 线平片、三维 CT 重建和磁共振成像（MRI）的组合。
通过循证指南回顾，确定：（1）MRI 用于确定韧带完整性是否可以预测手术干预的必要性；以及（2）是否有任何影像学发现可以辅助预测临床结局。
使用美国国立医学图书馆/PubMed 数据库和 Cochrane 图书馆对与胸腰椎创伤相关的文献进行系统综述。选择专门针对胸腰椎脊柱创伤影像学评估的临床研究进行综述。
2278 项研究中有 2 项符合纳入标准。1 项回顾性研究（III 级）和 1 项前瞻性队列研究（III 级）提供的证据表明，在急性胸腰椎创伤中增加 MRI 扫描可以预测手术干预的必要性。没有足够的证据表明 MRI 可以帮助预测急性创伤性胸腰椎脊柱损伤患者的临床结局。
本循证指南提供 B 级推荐，即急性胸腰椎脊柱创伤患者的影像学发现可以预测手术干预的必要性。本循证指南提供了 I 级不足的推荐，即没有足够的证据确定影像学发现是否可以辅助预测急性胸腰椎脊柱损伤患者的临床结局。
问题 1：创伤性胸腰椎骨折患者是否有影像学表现可以预测手术干预的必要性？
推荐 1：由于 MRI 已被证明可以影响高达 25%的胸腰椎骨折患者的治疗管理，因此在确定手术必要性时，临床医生可能会使用 MRI 评估后纵韧带复合体的完整性。推荐强度：B 级。
问题 2：创伤性胸腰椎骨折患者是否有影像学表现可以辅助预测临床结局？
推荐 2：由于发表的研究较少，没有足够的证据表明影像学发现可作为胸腰椎骨折临床结局的预测因素。推荐强度：I 级不足。本指南的全文可在以下网址查看：https://www.cns.org/guideline-chapters/congress-neurological-surgeons-systematic-review-evidence-based-guidelines/chapter_3.
