A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

Yunshan Su,Dong Ren,Yan Zou,Jian Lu,Pengcheng Wang

doi:10.6061/clinics/2016(06)02

Abstract

OBJECTIVE:To evaluate the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures.METHODS:Fifty-six cases of thoracolumbar vertebral fractures treated in our trauma center from October 2012 to October 2013 were included in this study. The fractures were classified by the anteroposterior classification, whereas the severity of intervertebral disc injury was evaluated using magnetic resonance imaging. The Spearman correlation coefficient was used to analyze the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar fractures, whereas a χ2 test was adopted to measure the variability between different fracture types and upper and lower adjacent disc injuries.RESULTS:The Spearman correlation coefficients between fracture types and the severity of the upper and lower adjacent disc injuries were 0.739 (PU<0.001) and 0.368 (PL=0.005), respectively. It means that the more complex Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications are the disc injury is more severe. There was also a significant difference in the severity of injury between the upper and lower adjacent discs near the fractured vertebrae (p<0.001).CONCLUSIONS:In thoracolumbar spinal fractures, the severity of the adjacent intervertebral disc injury is positively correlated with the anteroposterior fracture type. The injury primarily involves intervertebral discs near the fractured end plate, with more frequent and severe injuries observed in the upper than in the lower discs. The presence of intervertebral disc injury, along with its severity, may provide useful information during the clinical decision-making process.

Highlights

Thoracolumbar vertebral fractures are usually complicated by varying degrees of intervertebral disc injury [1,2]
Adopting the classification system for intervertebral disc injury proposed by Sander et al, [5] upper and lower adjacent disc injuries were divided into four grades from Grade 0 to Grade 3 based on the Magnetic resonance imaging (MRI) data
This study indicates that the degree of intervertebral disc injury increases with the severity of the fracture and that intervertebral disc injury is positively correlated with the Arbeitsgemeinschaft fur Osteosynthesefragen (AO) fracture type

Summary

Introduction

Thoracolumbar vertebral fractures are usually complicated by varying degrees of intervertebral disc injury [1,2]. Spinal stability is primarily assessed based on the fracture type and the integrity of the posterior ligamentous complex, whereas the presence of intervertebral disc injury is frequently ignored. Intervertebral disc injury is an important factor that influences postoperative spinal stability and prognosis [3,4]. The common clinical classification systems for thoracolumbar vertebral fractures, including the AO classification, Denis classification, load-sharing classification and thoracolumbar injury classification and severity score (TLICS), have not provided an adequately detailed description for the severity of intervertebral disc injury. Sander et al [5] proposed a novel classification system for the severity of intervertebral disc injury based on the MRI

Methods

Results

Conclusion