Prediction of posterior ligamentous complex injury in thoracolumbar fractures using non-MRI imaging techniques
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We aimed to formulate a radiological index based on plain radiographs and computer tomography (CT) to reliably detect posterior ligamentous complex (PLC) injury without need for MRI.
Sixty out of 148 consecutive thoracolumbar fractures with doubtful PLC were assessed with MRI, CT and radiographs. PLC injury was assessed with the following radiological parameters: superior-inferior end plate angle (SIEA), vertebral body height (BH), local kyphosis (LK), inter-spinous distance (ISD) and inter-pedicular distance (IPD) and correlated with MRI findings of PLC injury. Statistical analysis was performed to identify the predictive values for the parameters to identify PLC damage.
MRI identified PLC injury in 25/60 cases. The ISD and LK were found to be significant predictors of PLC injury. On radiographs the mean LK with PLC damage was 25.86° compared to 21.02° with an intact PLC (p = 0.006). The ISD difference was 6.70 mm in cases with PLC damage compared to 2.86 mm with an intact PLC (p = 0.011). In CT images, the mean LK with PLC damage was 22.96° compared to 18.44° with an intact PLC ( p = 0.019). The ISD difference was 3.10 mm with PLC damage compared to 1.62 mm without PLC damage (p = 0.005).
On plain radiographs the presence of LK greater than 20 °(CI 64–95) and ISD difference greater than 2 mm (CI 70–97) can predict PLC injury. These guidelines may be utilised in the emergency room especially when the associated cost, availability and time delay in performing MRI are a concern.
KeywordsPosterior ligamentous complex Thoracolumbar fractures Interspinous distance Local kyphosis Spinal deformity
Compliance with ethical standards
Ganga Orthopaedic Research & Education Foundation, Coimbatore.
Conflict of interest
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 2.Hwee Weng Dennis H, Hwan Tak H (2011) A review of thoracolumbar spine fracture classifications. J Orthop Trauma 1:235406Google Scholar
- 14.Morais DF, de Melo Neto JS, Meguins LC, Mussi SE, Ferraz Filho L JR, Tognola WA (2014) Clinical applicability of magnetic resonance imaging in acute spinal cord trauma. Eur Spine J 23(7):1457–1463Google Scholar
- 23.Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, Bühren V (2010) Operative treatment of 733 patients with acute thoracolumbar spinal injuries: comprehensive results from the second, prospective, internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. Eur Spine J 19(10):1657–1676CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Rihn JA, Yang N, Fisher C, Saravanja D, Smith H, Morrison WB, Vaccaro AR (2010) Using magnetic resonance imaging to accurately assess injury to the posterior ligamentous complex of the spine: a prospective comparison of the surgeon and radiologist: Clinical article. J Neurosurg Spine 12(4):391–396CrossRefPubMedGoogle Scholar