Abstract
Purpose
To determine whether MRI done prior to reduction altered the surgeon's choice of reduction method.
Method
One hundred and four patients were included in this retrospective review. The first component of this study identified the presence of uncontained, herniated discs in this patient group. The MRI scans were reviewed by two teams including a radiology team and orthopaedic team. These scans were assessed without clinical information and the teams did not have access to the patient notes. An Interrater agreement assessment was applied to the data and the most reliable inter-observer variables of disc injury were chosen to identify the presence of a herniated uncontained intervertebral disc. The second part of this study entailed a detailed clinical note review specifically looking at type of reduction, whether it was intended and the reason why a certain type of reduction was chosen. These naturally divided the 104 patients into 5 cohorts including; closed reduction, Intended open reduction due to the documented presence of a ‘dangerous disc’, open reduction following failed closed reduction, open reduction with no documented reason and open reduction due to delay in presentation. Since closed reduction would not be considered in delayed presentations this cohort was removed from data analysis. Additionally the pre and post reduction neurological status was noted.
Results
The cohort that included ‘Intended open reduction due to presence of an uncontained disc’ included 11.5% of patients in this data subset. These cases all had MRI's that were documented to have influenced the type of reduction (p=0.006). However 57% of patients with uncontained discs had had attempted closed reduction; 31% were successful and 27% failed. Using the binomial exact test we calculate the 95% confidence interval showing .054 and .208; thus the reduction method was significantly changed by performing MRI. One patient developed neurological compromise after failed closed reduction. This formed 3.6% of 28 uncontained discs that had attempted closed reduction.
Conclusion
The risk of neurological deterioration with closed reduction in the presence of an uncontained disc the risk is 3.6% with an overall risk of 2.2% for this cohort. This study confirms pre-reduction MRI to significantly affect surgeon's decision making. Therr is a significant cost to MRI investigation and the incidence of neurological deterioration of 2.2% needs to be seen against this.
ONE DISCLOSURE
