Concordance in the radiological diagnosis of thoracolumbar spine fractures

Abstract

Introduction: Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment to obtain good clinical results is essential, with many classifications being proposed for this purpose.

Objective: To determine the external validity of radiographic and computed tomography (CT) measurements for the most used classifications, and decide on the type of treatment required. The working hypothesis is the existence of external validity of radiographic measurements.

Material and method: A sample of patients with thoracolumbar fracture was selected. Three spine specialists and a resident performed measurements on anteroposterior and lateral radiographic images as well as coronal, sagittal and axial CT slices. Fractures were classified as stable or unstable, evaluating the degree of intra-and interobserver agreement based on a standard observer. Sagittal index of Farcy, lateral wedging, Beck Index, traumatic regional angulation and channel occupancy were studied.

Results: All indicators studied, except the lateral wedging, showed a high degree of concordance.

Conclusions: Instability determinants studied with radiographs and CT, which had obtained statistical significance, are reliable and accurate for the classification of thoracolumbar fractures and, therefore, to indicate an appropriate treatment.

Keywords: Diagnosis; Diagnóstico; Fracturas de raquis; Interobserver variability; Intraobserver variability; Spine fractures; Variabilidad interobservador; Variabilidad intraobservador.