Differentiation Between Acute and Old Fractures in The Thoracic and Lumbar Spine: Observer Agreement.

Lee, Kyeong Seok; Bae, Won Kyoung; Jho, Won Soo; Bae, Hack Gun; Doh, Jae Won; Yun, Il Gyu

Original Article

Journal of Korean Neurosurgical Society 1996;25(7): 1364-1370.

Kyeong Seok Lee, Won Kyoung Bae, Won Soo Jho, Hack Gun Bae, Jae Won Doh, Il Gyu Yun

¹Department of Neurosurgery, Diagnostic Radiology, Soonchunhyang University, Chonan Hospital, Chonan, Korea.
²Department of Diagnostic Radiology, Soonchunhyang University, Chonan Hospital, Chonan, Korea.

ABSTRACT

Differentiation between acute and old fractures in the thoracic and lumbar spine is often difficult. We have evaluated the intraobserver agreement and interobserver variability of interpretations. We have prepared 50 cases from 40 patients with thoracic or lumbar spine fracture for evaluation. At first, two radiologist interpreted each of the 50 cases, Only by using plain roentgenograms. Then, they interpreted the cases again using also spine CT, MRI, bone scintigrams and follow-up roentgenograms. Intraobserver agreement was found to be 78% in Doctor A, and 76% in Doctor B. Interobserver agreement was only 62% at first. It was 88%, when they used CT, MRI, bone scintigrams and follow-up roentgenograms. It was not easy to differentiate the old fractures from acute one only by plain roentgenograms. Differentiation was more difficult, when the patient was female or over 55 years old. Plain roentgenography in hyperextension posture seems to be a simple but useful method for the diagnosis of the acute fracture. MRI was more valuable than CT or bone scintigraphy to differentiate the old fractures from the acute ones.

Key Words: Differential diagnosis; Observer agreement; Acute fracture; Old fracture; Thoracic and lumbar spine; Compression fracture