Plain radiography versus computed tomography scans in the diagnosis and management of thoracolumbar burst fractures

Study Design. The role of plain radiography in the diagnosis and management of thoracolumbar burst fractures was evaluated when compared with computed tomography (CT) scans. Objective. To determine the accuracy of plain radiography in detecting thoracolumbar burst fractures when CT scans were used as the gold standard, and to assess the impact of disagreement of the results between plain radiographs and CT scans on treatment plan. Summary of Background Data. There have been few studies comparing the value of plain radiography with that of CT scans in the diagnosis and management of thoracolumbar burst fractures. Methods. Radiographs of 73 patients with a compression or burst fracture were reviewed independently by 3 residents and 3 spine surgeons. The results of CT scans were used as the gold standard to determine the accuracy of plain radiography for the diagnosis. More quantitative results of 57 patients with a burst fracture based on plain radiographs alone were compared with those after addition of CT scans. The disagreement between the results was analyzed, and the impact of disagreement on treatment plan was defined as the changes of load sharing score between <= 6 and >= 7. Results. The accuracy of plain radiography improved with the experience of observers. The results on the load sharing score agreed between plain radiographs alone and radiographs with CT scans only for 56%, indicating moderate agreement. The impact of disagreement on treatment plan was significant (P < 0.05). This disagreement was most contributed by the underestimation for vertebral body comminution based on plain radiographs. Conclusion. The accuracy of plain radiography is acceptable in the qualitative sense, and would improve with the experience of observers. However, plain radiography alone would not be adequate when used for more quantitatively assessing the fractures. Addition of CT scanning is necessary for treatment planning.