MRI and discography in traumatic intervertebral disc lesions

In this study, we evaluated magnetic resonance imaging (MRI) in trauma patients for assessing traumatized adjacent discs of fractured vertebrae before dorsoventral stabilization. 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 with 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 traumatized adjacent cranial and caudal discs in 22 discs. In seven cases, only the cranial adjacent disc was affected. Moreover, 17 cases of intradiscal bleeding, 13 intraosseous hemiations into the fractured vertebrae, and 20 annular tears were visualized 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 noninvasive method for assessing fractures of the thoracolumbar spine, may detect traumatized adjacent intervertebral discs. MRI is superior to intraoperative discography. The performance of MRI of the thoracolumbar spine is recommended before dorsoventral stabilization in trauma patients, as it can reveal additional preoperative information such as fractures, disc, and associated ligament injuries.