Impact of MRI on the management of CT-defined AO spine A/B thoracolumbar fractures.
Emergency spine MRI changed treatment strategy in 12% of thoracolumbar trauma patients.
Impact of MRI on the management of CT-defined AO spine A/B thoracolumbar fractures.
To assess the added value of emergency spine MRI compared with CT alone in patients with AO Spine A/B thoracolumbar trauma without neurological deficit, focusing on clinical management.
This retrospective single-center study included consecutive trauma patients who underwent both CT and spine MRI between November 2023 and October 2025.
Management change was driven by MRI-detected posterior ligamentous complex injury in 17 patients (partial in 8, complete in 9), by occult spinal cord injury without clinical translation in 2 patients, and by both mechanisms simultaneously in 4 patients.
AO Spine fracture classification changed after MRI in 39 patients (25%), reflecting substantial overall agreement between MRI and CT (κ = 0.64; p < 0.001).
No CT-based variable remained independently associated with management change after adjustment.
In selected patients with neurologically intact thoracolumbar trauma, emergency spine MRI modified therapeutic management in 12% of cases, primarily by revealing posterior ligamentous complex injuries and occult spinal cord findings not apparent on CT.
These results support an indication-driven rather than systematic use of MRI.