European Spine Journal

, Volume 22, Issue 3, pp 461–474 | Cite as

The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature

  • Joost J. van MiddendorpEmail author
  • Alpesh A. Patel
  • Michael Schuetz
  • Andrei F. Joaquim
Review Article



The diagnostic assessment and prognostic value of the posterior ligamentous complex (PLC) remains a controversial topic in the management of patients with thoracolumbar spinal injury. The purpose of this review was to critically appraise the literature and present an overview of the: (1) precision, (2) accuracy, and (3) validity of detecting PLC injuries in patients with thoracic and lumbar spine trauma.


Studies evaluating the precision, accuracy and/or validity of detecting and managing PLC injuries in patients with thoracic and/or lumbar spine injuries were searched through the Medline database (1966 to September 2011). References were retrieved and evaluated individually and independently by two authors.


Twenty-one eligible studies were identified. Few studies reported the use of countermeasures for sampling and measurement bias. In nine agreement studies, the PLC was assessed in various ways, ranging from use of booklets to a complete set of diagnostic imaging. Inter-rater and intra-rater kappa values ranged from 0.188 to 0.915 and 0.455 to 0.840, respectively. In nine accuracy studies, magnetic resonance (MR) imaging was most often (n = 6) compared with intra-operative findings. In general, MR imaging tended to demonstrate relatively high negative predictive values and relatively low positive predictive values for PLC injuries.


A wide variety of methods have been applied in the evaluation of precision and accuracy of PLC injury detection, leaving spinal surgeons with a multitude of variable results. There is scant clinical evidence demonstrating the true prognostic value of detected PLC injuries in patients with thoracic and lumbar spine injuries. We recommend the conduct of longitudinal clinical follow-up studies on those cases assessed for precision and/or accuracy of PLC injuries.


Posterior ligamentous complex Thoracic spine Lumbar spine Thoracolumbar spine Spinal injuries Systematic review 



We would like to thank Dr. Priyesh Dhoke and Dr. Hamish Deverall for their insightful discussions during the writing of this manuscript.

Conflict of interest

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The authors have no financial interest in the subject of this article. The manuscript submitted does not contain information about medical device(s).

Supplementary material

586_2012_2602_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 24 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Joost J. van Middendorp
    • 1
    • 2
    • 3
    Email author
  • Alpesh A. Patel
    • 4
  • Michael Schuetz
    • 3
    • 5
  • Andrei F. Joaquim
    • 6
    • 4
  1. 1.Stoke Mandeville Spinal FoundationNational Spinal Injuries Centre, Stoke Mandeville HospitalAylesburyUK
  2. 2.Harris Manchester CollegeUniversity of OxfordOxfordUK
  3. 3.Institute of Health and Biomedical InnovationQueensland University of TechnologyKelvin GroveAustralia
  4. 4.Department of Orthopaedic Surgery and RehabilitationLoyola UniversityChicagoUSA
  5. 5.Trauma ServicePrincess Alexandra HospitalBrisbaneAustralia
  6. 6.Division of Neurosurgery, Department of NeurologyState University of CampinasCampinasBrazil

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