Clinical role of radiography for thoracic spine fractures in daily practice in the MDCT era: A retrospective review of 255 trauma patients

Purpose To retrospectively assess the diagnostic efficacy of radiography in detecting vertebral body fractures of the thoracic spine compared with MDCT, to assess the confounding factors reducing the diagnostic efficacy, and to investigate the outcomes of radiographically overlooked patients. Materials and methods Two hundred fifty-five patients suspected of thoracic spine fractures were enrolled. We assessed the diagnostic efficacy of radiography for the patients sub-grouped based on five confounding factors: chest abnormalities, head injuries, cervical spine fractures, upper extremity injuries, and age of 65 years or older. We investigated the outcomes of radiographically overlooked patients. Results Three hundred fifty-one vertebral body fractures were detected. The per-fracture sensitivities and specificities were 55 %and 94 %for vertebral body fractures and 41 and 99 %for unstable fractures. In patients with upper extremity injuries or aged 65 years or older, radiography was less sensitive in detecting the unstable fractures (P\0.05). Nineteen patients were overlooked by radiography; two had neurological deficits and needed surgical fixation; 15 with no neurological deficit were conservatively treated with uneventful outcomes. Conclusion Radiography had low sensitivity but high specificity. In daily practice, primary use of MDCT is beneficial for patients with neurological deficit or upper extremity injuries or elderly patients.