Purpose
The radiological examination including plain radiography, CT and MRI are critical to assess the severity of the instability, to diagnose the fracture type and to select the appropriate ...treatment strategy for the thoracic and lumbar vertebral fractures. The aim of this prospective observational study was to investigate the effect of magnetic resonance imaging (MRI) on decision making for the diagnosis and treatment of acute thoracic and lumbar vertebral fractures.
Methods
Consecutive 180 patients with acute thoracic and/or lumbar vertebral fractures were included in the study. The fracture pattern was evaluated by using initial radiographs, computed tomography (CT) and MRI within 24 h of trauma. Fractures were classified according to AO classification before and after MRI. TLICS classification was also used to decide treatment plan. MRI findings were compared to surgical findings in the surgically treated patients.
Results
A significant moderate agreement was found between Xray + CT and post-MRI classifications for all fracture types (Kappa = 0.511;
p
< 0.001). In 101 patients with new findings on MRI, a significant moderate correlation was observed between Xray + CT and post-MRI classifications in the fracture re-classification (Kappa = 0.441,
p
< 0.001). There was a significant change in the treatment plan of patients with new findings on MRI according to Xray + CT (
p
< 0.0001). After MRI evaluation, the treatment plan changed in favor of surgery in 33.9% of patients who were scheduled for conservative treatment according to Xray + CT (
p
< 0.0001).
Conclusion
Since MRI assessment of acute thoracic and/or lumbar injuries has led to a remarkable treatment change decision that confirms intraoperative findings of the patients who were decided to undergo surgery, MRI should be obtained in thoracic and lumbar vertebral fractures, regardless of the CT and plain radiographic findings.
Level of evidence
Level II, prospective observational study.
Glutaric aciduria type I (GA1; OMIM #231670) is an autosomal recessively inherited and treatable disorder characterized by the accumulation and irregular excretion of glutaric acid due to a defect in ...the glutaryl-CoA dehydrogenase enzyme involved in the catabolic pathways of
l
-lysine,
l
-hydroxylysine, and
l
-tryptophan. Glutaryl-CoA dehydrogenase is encoded by the
GCDH
gene (OMIM #608801), and several mutations in this gene are known to result in GA1. GA1 usually presents in the first 18–36 months of life with mild or severe acute encephalopathy, movement disorders, and striatal degeneration. Few cases of adult-onset GA1 have been described so far in the literature, often with non-specific and sometimes longstanding neurological symptoms. Since a preventive metabolic treatment is available, neurologists must be aware of this rare but likely underdiagnosed presentation, especially when typical neuroimaging features are identified. Here, we describe 35-year-old presenting with headache and subjective memory problems. There was no history of dystonic movement disorders. Neurological examination and neurocognitive tests were normal. Brain MRI scan revealed white matter abnormalities associated with subependymal nodules and mild frontotemporal hypoplasia suggestive of glutaric aciduria type 1 (GA1). Genetic testing confirmed the presence of homozygous c.1204C > T (p.R402W) variant in the
GCDH
gene, inherited from heterozygous parents.
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