Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography

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

doi:10.1016/j.spinee.2006.07.014

Cited by 95 publications

(59 citation statements)

References 17 publications

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“…T1/T2-w sequences in axial, sagittal and coronal planes should be carried out in these patients, because they give as much osseous information as the CT scan does, especially in T1-w sequences. We agree with other authors that the best information regarding the PLC injury is offered by the FS-T2-w and STIR sequences [6,7,17,20], which have improved soft tissue damage information when compared with X-rays and CT scans. However, even using these, we still have difficulties in discriminating between complete and incomplete ruptures of the posterior structures and, most of all, in differentiating self-healing disruptions from those that need to be surgically fixed to prevent a further collapse.…”

Section: Discussionsupporting

confidence: 90%

“…These images were used to define the morphological pattern of the fractures, the status of the intervertebral discs and especially the integrity of the posterior ligamentous complex (supraspinous and interspinous ligaments, the ligamentum flavum and both facet capsules). Ligament disruption was diagnosed when a loss of ligamentous continuity was seen (clear rupture of the ''black-stripe'' on T1-and FS-T2-w/STIR sequences), and ligament injury when an abnormal signal intensity within the ligament was present on T1-w and/or FS-T2-w/STIR sequences [7].…”

Section: Methodsmentioning

confidence: 99%

“…The ISS score, developed from the TLICS, defines patients scoring more than four points as potentially unstable and having a 95% chance of requiring surgery [7]; finally, patients' particular clinical qualifiers (open fractures, multisystem trauma, comorbidities, etc.). Patients were treated either conservatively with 3 months of TLSO or with surgical instrumented fusion as required.…”

Section: Methodsmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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%

“…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. Applying a similar study design, the STSG subsequently asked participants to rank a list of various criteria potentially indicative of PLC injury in the setting of normal plain radiographs [33]. This time ''diastasis of the facet joints'' on CT was ranked as most important indicator for PLC injury, followed by ''posterior oedema (high signal intensity) in region of PLC elements'' on T2 STIR or FAT SAT sagittal MR imaging and ''Disrupted PLC components'' on T1 sagittal MR imaging.…”

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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Surgical management of cranial thoracolumbar stenosis and concurrent kyphoscoliosis in a dog by dorsal vertebral stabilisation using low‐profile three‐dimensional printed patient‐specific drill guides

Hajdu,

Oxley,

Driver

2024

Vet Record Case Reports

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The study described the clinical and imaging findings, treatment and outcome for a British bulldog with cranial thoracic vertebral canal stenosis and thoracolumbar kyphoscoliosis. Data on clinical presentation, diagnostic imaging, surgical procedure, complications and outcome were evaluated. Multiple thoracic vertebral body and dorsal arch malformations were detected by computed tomography and magnetic resonance imaging, resulting in spinal cord compression due to vertebral canal stenosis at T5–T6 and T9–T10, as well as kyphoscoliosis. Surgical vertebral stabilisation between T2 and T10 was performed by using a novel design of unilateral three‐dimensional printed patient‐specific drill guides, to preserve the dorsal spinous processes. Neurological signs had completely resolved 2 months after surgery. Follow‐up examination and computed tomography scan 15 months postoperatively revealed normal neurological status, implant stability and no progression of kyphoscoliosis. This novel design of unilateral three‐dimensional printed patient‐specific drill guides allowed dorsal thoracic vertebral stabilisation without resection of dorsal spinous processes and multiple‐level stabilisation.

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Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography

Cited by 95 publications

References 17 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

Surgical management of cranial thoracolumbar stenosis and concurrent kyphoscoliosis in a dog by dorsal vertebral stabilisation using low‐profile three‐dimensional printed patient‐specific drill guides

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