Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma

Vaccaro, Alexander R.; Lee, Joon Y.; Schweitzer, Karl M.; Lim, Moe R.; Baron, Eli M.; Öner, F. Cumhur; Hulbert, R. John; Hedlund, Rune; Fehlings, Michael G.; Arnold, Paul M.; Harrop, James; Bono, Christopher M.; Anderson, Paul A.; Anderson, D. Greg; Harris, Mitchel B.; Group, Spine Trauma Study

doi:10.1016/j.spinee.2006.01.017

Cited by 96 publications

(64 citation statements)

References 16 publications

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“…Early classifications were designed through the analysis of plain X-rays and CT scan, which are examination tools not completely able to show soft tissue anatomy [8,10,11,13]. With these, the suspicion of ligament injury has to be assessed by indirect indicators such as focal kyphosis, interspinous spacing, diastasis of the facet joints or more than 50% of anterior body compression [2,16,17].…”

Section: Introductionmentioning

confidence: 99%

Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment

et al. 2011

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Introduction The role of magnetic resonance imaging (MRI) has recently been enhanced in the diagnosis of thoracolumbar fractures due to its ability to examine soft tissue injury. Material and methods We conducted a prospective study to analyze the usefulness of MRI in fracture diagnosis and its influence on treatment decision making. Thirty-three patients were enrolled after suffering an acute traumatic thoracolumbar fracture. Osteoporotic or pathologic fractures were excluded. Fractures were initially classified using X-ray and CT scan following the AO classification. Afterward, a selective MRI protocol was performed with T1 and T2-weighted FS/STIR sequences. Subsequently, fractures were classified according to the TLICS system and reclassified following the AO system. Analysis was performed before and after MRI, focusing on: diagnostic changes, occult fractures and differences in treatment decision making. Results Thirty patients (15 males, 15 females) with an average age of 39.9 years were studied. Forty-one fractures were initially diagnosed using plain X-rays and CT scans, while MRI diagnosed 50 fractures and 9 vertebral contusions. MRI modified our diagnosis in 40% of our patients (discovering 18 occult injuries), the classification of fracture pattern in 24% of the fractures (mostly upgrading type A to type B patterns) and the therapeutic management in 16% of our patients. Conclusions MRI seems to be a useful tool in the evaluation of thoracolumbar acute fractures, as it allows a better visualization of the posterior complex integrity and of the levels involved, offering additional information compared to traditional diagnostic tools.

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Section: Introductionmentioning

confidence: 99%

Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment

et al. 2011

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“…Eight studies evaluated the agreement on PLC injury evaluation [15][16][17][18][19][20][21][22], another eight studies evaluated the accuracy of detecting PLC injuries [23][24][25][26][27][28][29][30] and one study evaluated both agreement and accuracy [31]. Four studies reported on different validity components of PLC injuries [32][33][34][35].…”

Section: Search and Screening Resultsmentioning

confidence: 99%

“…In a survey study among 28 members of the STSG, participants were asked to rank a list of various criteria potentially indicative of PLC injury [34]. Vertebral body translation as discerned on plain radiographs was ranked as the most important indicator for PLC disruption, followed by ''interspinous spacing greater than that of level above or below'' as discerned on anteroposterior plain radiograph and ''diastasis of the facet joints'' on CT.…”

Section: Accuracy Valuesmentioning

confidence: 99%

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

et al. 2012

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Purpose 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. Methods 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. Results 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. Conclusions 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.

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“…O diagnóstico de certeza da lesão ligamentar orienta a classificação das lesões traumáticas da coluna vertebral e a indicação do tratamento cirúrgico ou conservador 4 . Apesar da importância do CLP na avaliação da estabilidade do segmento vertebral, e como parâmetro de classificação das lesões traumáticas da coluna vertebral, tem sido difícil a obtenção de consenso na sua identificação e diagnóstico 3 . O diagnóstico das lesões do CLP apresenta grande limitação e até o momento não existe um sistema preciso para a identificação ou diagnóstico das lesões desse complexo.…”

Section: Resultsunclassified

“…O diagnóstico das lesões do CLP apresenta grande limitação e até o momento não existe um sistema preciso para a identificação ou diagnóstico das lesões desse complexo. O exame físico pode não ser confiável e as radiografias simples e a tomografia computadorizada pode demonstrar a lesão de modo indireto, pois os ligamentos não podem ser visualizados nesses exames 3,11,12 . Os resultados observados em nossa série de pacientes confirmam os relatos de estudos anteriores que demonstraram a dificuldade para o diagnóstico das lesões do CLP 3,5,6 .…”

Section: Resultsunclassified

Correlação das imagens da ressonância magnética e observação intra operatória nas lesões traumáticas da coluna vertebral

et al. 2012

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RESUMOObjetivo: Avaliar a acurácia e a reprodutibilidade das imagens da ressonância magnética (RM) nas lesões ligamentares traumáticas da coluna vertebral. Método: Estudo retrospectivo para avaliação das imagens da RM de 32 pacientes com lesões traumáticas da coluna vertebral submetidos a tratamento cirúrgico. A avaliação das lesões do complexo ligamentar posterior (CLP) por imagens da RM foi realizada independentemente por dois radiologistas. Um grupo de pacientes tinha exames com inclusão de sequência com supressão de gordura sensível ao líquido (STIR ou SPAIR T2), além das imagens de rotina e no outro grupo os exames de RM não incluíam imagens com a supressão da gordura. As avaliações dos exames de imagem foram comparadas com as observações obtidas durante o ato cirúrgico. Foi realizada a analise de reprodutibilidade intra e interobservador entre os dois radiologistas pelo cálculo do coeficiente Kappa. Resultados: Foi observada lesão do CLP em 21/32 pacientes. De forma geral a sensibilidade da RM para lesões do CLP variou entre 88,9% a 100% e a especificidade entre 0 e 50%. A concordância entre a avaliação dos radiologistas foi maior nos exames de ressonância magnética sem a supressão da gordura (κ=0,6) do que nos exames que incluíram sequências com supressão (κ=0,34). Conclusão: A avaliação de lesões dos ligamentos posteriores por meio da RM pelos radiologistas resultou em boa sensibilidade em relação aos achados cirúrgicos, porém com baixa especificidade, reproduzindo resultados da literatura. Na casuística atual a utilização do sinal de edema presente nas sequências com supressão de gordura diminuiu a concordância interobservador.Descritores: Fraturas da coluna vertebral; Traumatismos da coluna vertebral; Imagem por ressonância magnética/utilização.

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Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma

Cited by 96 publications

References 16 publications

Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment

Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment

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

Correlação das imagens da ressonância magnética e observação intra operatória nas lesões traumáticas da coluna vertebral

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