Thoracolumbar Disc Injury –  Indication for Anterior Disc Replacement Using Magnetic Resonance Imaging

Summary

A prospective analysis of patients with type A3 thoracolumbar fractures (AO classification), without injuries to the nervous system and with findings of higher grades of intervertebral disc and endplate injuries on MRI, was performed. The aim of the study was to compare clinical outcome and radiological findings after surgery with and without disc replacement and to gather statistically significant results of indications for anterior disc replacement. The group consisted of 83 patients (16– 77 years old, average 48.4 years). The follow‑up period was 18 months. The group of patients was divided into three subgroups according to treatment modality: 1. treated by posterior transpedicular screw fixation; 2. by combined fixation and 3. by anterior disc or vertebral body replacement. The data was subjected to statistical evaluation. The anterior replacement subgroup compared with the transpedicular subgroup showed statistically significant improvement in final clinical outcome and radiological findings. The patients treated by transpedicular fixation suffered more from moderate to severe pain and occasional absence from work, were less able to return to previous employment, unable to return to full‑ time work or were completely disabled and revealed higher rates of kyphotization 18 months post‑injury, compared with patients with anterior replacement. The authors recommend anterior disc or vertebral body replacement in cases of type A3 fractures with intervertebral disc and endplate injuries grade 3 or 4. Post‑traumatic assessment of the disc and vertebral endplate trauma severity using MRI is of significance for surgical treatment of thoracolumbar fractures, particularly for indication of anterior disc replacement.

Key words:
spinal injury – intervertebral disc – 
magnetic resonance imaging – disc replacement