Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Traumatic Thoracolumbar Fractures: A Propensity Score Matched Analysis

Introduction: Diagnosis of traumatic thoracolumbar spine fractures is commonly made with quick and relatively inexpensive computed tomography (CT). Magnetic resonance imaging (MRI), alternatively, has higher sensitivity for ligamentous and nervous injury and may better guide operative decision-making, but is more costly and slower to obtain. Preferred diagnostic imaging modalities can differ between surgeons. The purpose of this study is to evaluate the differences in inpatient outcomes in patients with thoracolumbar fractures receiving preoperative CT alone, MRI alone, or both.

Methods: The National Trauma Data Bank was searched from 2017-2021 for all adult patients with a traumatic thoracolumbar fracture who received imaging followed by surgical fusion. Patients were divided into study groups based on whether they received CT alone, MRI alone, or both imaging modalities preoperatively. Patients were randomly sampled and propensity score matching was performed based on patient demographics, comorbidities, and injury severity. One-way ANOVA and Person’s χ2 tests were used to compare study groups.

Results: A total of 14396 eligible patients were identified; 4322 had CT alone, 3978 had MRI alone, and 6096 had both. One thousand patients in the MRI group were randomly sampled, then propensity score matched with the CT and both modalities group. Imbalance was eliminated or minimized for all variables. Following matching, patients in the MRI alone group had the earliest time from presentation to the ED to fusion (52.70 vs. 61.88 vs. 61.34 hours, p=0.02) and time between imaging and fusion (40.19 vs. 57.91 vs. 58.03 hours, p< 0.01) compared to the CT and both modalities group. Additionally, the MRI group had the shortest length of stay (9.96 vs. 12.11 vs. 11.25 days, p< 0.01), lowest complication rate (11% vs. 17.60% vs. 19.4%, p< 0.01), and highest rate of discharge to home (42.7% vs. 33.8% vs. 34.1%, p< 0.01).

Conclusion : Patients suffering from traumatic thoracolumbar fractures who received MRI alone experience better outcomes compared to patients who received CT alone or both modalities prior to surgical fusion. Deferring imaging for MRI may be associated with improved outcomes. Further research is needed to determine optimal initial imaging strategies in these patients.