Diagnostic Value of Various Morphological Features of Horizontal and Vertical Laminar Fractures for Posterior Ligamentous Complex Injury of the Thoracolumbar Spine as Defined by Magnetic Resonance Imaging
“…Upon encroachment of the posterior vertebral wall and posterior ligamentous complex, the posteriorly displaced fracture fragment encroaches into the spinal canal [ 18 , 19 ] with a high risk of neurological impairment [ 20 ]. Mohamed M. Aly et al [ 21 ] showed that the absence of horizontal laminar fracture, spinous process fracture, interspinous widening > 4 mm, and facet joint malignment has a high negative predictive value of PLC injury. When the interpedicular distance between the two sides of the vertebral body widens, laminar fractures result when the force exceeds the durability of the lamina.…”
Background
Surgeons often encounter recurrent kyphosis of Cobb angle following thoracolumbar burst fracture surgery. Some factors affecting postoperative correction loss have been studied in previous studies, but few have examined the relationship between laminar fractures and postoperative loss of correction.
Methods
The clinical data of 86 patients with thoracolumbar burst fracture who met the inclusion criteria and were admitted to our Department of Spine Surgery between 2013 and 2020 was retrospectively analyzed. To examine the association between laminar fracturs and postoperative correction loss, demographic and radiographic characteristics of the two groups were analyzed.
Results
The presence or absence of laminar fractures was statistically different between the two groups (P < 0.05). Binary logistic regression analysis showed that laminar fractures and preoperative Cobb were statistically significant in the two groups. There were statistically significant differences in the degree of injury of laminar fractures in the coronal plane between the two groups (P < 0.05).
Conclusion
This study investigated that the presence or absence of laminar fractures and preoperative Cobb contribute to loss of correction after thoracolumbar burst fracture surgery. There was a statistically significant difference between full-length and partial-length laminar fractures on the loss of postoperative correction of thoracolumbar burst fractures with laminar fractures.
“…Upon encroachment of the posterior vertebral wall and posterior ligamentous complex, the posteriorly displaced fracture fragment encroaches into the spinal canal [ 18 , 19 ] with a high risk of neurological impairment [ 20 ]. Mohamed M. Aly et al [ 21 ] showed that the absence of horizontal laminar fracture, spinous process fracture, interspinous widening > 4 mm, and facet joint malignment has a high negative predictive value of PLC injury. When the interpedicular distance between the two sides of the vertebral body widens, laminar fractures result when the force exceeds the durability of the lamina.…”
Background
Surgeons often encounter recurrent kyphosis of Cobb angle following thoracolumbar burst fracture surgery. Some factors affecting postoperative correction loss have been studied in previous studies, but few have examined the relationship between laminar fractures and postoperative loss of correction.
Methods
The clinical data of 86 patients with thoracolumbar burst fracture who met the inclusion criteria and were admitted to our Department of Spine Surgery between 2013 and 2020 was retrospectively analyzed. To examine the association between laminar fracturs and postoperative correction loss, demographic and radiographic characteristics of the two groups were analyzed.
Results
The presence or absence of laminar fractures was statistically different between the two groups (P < 0.05). Binary logistic regression analysis showed that laminar fractures and preoperative Cobb were statistically significant in the two groups. There were statistically significant differences in the degree of injury of laminar fractures in the coronal plane between the two groups (P < 0.05).
Conclusion
This study investigated that the presence or absence of laminar fractures and preoperative Cobb contribute to loss of correction after thoracolumbar burst fracture surgery. There was a statistically significant difference between full-length and partial-length laminar fractures on the loss of postoperative correction of thoracolumbar burst fractures with laminar fractures.
“…31 Contrarily, a vertical LF tear is typically caused by a vertical laminar fracture due to axial compression and is not associated with other ligamentous injuries. 34 Figure 6.Magnetic resonance imaging findings of ligamnetum flavum injury. (A-B) An illustration of the coronal view of a vertebra with the dotted lines indicates the silhouettes of the laminae and inferior articular processes behind the ligament; showing a vertical laminar fracture with an underlying vertical tear in ligamentum flavum ( black arrow, A ) and a horizontal laminar fracture with an underlying horizontal tear in ligamentum flavum (blue arrow, B ); (C-D) Axial T2 image can help to distinguish between horizontal and vertical ligamentum flavum it tear as it shows unilateral focal ligamentum flavum tears for vertical tears (green arrow, C ) and a diffusely macerated tears for horizontal tear ( two black arrows, D ); (E) Sagittal STIR image shows black stripe discontinuity due to horizontal ligament flavum tear (green arrow) and supraspinous ligament rupture (black arrow) and high signal intensity due to interspinous ligament rupture (red arrow).…”
Section: Discussionmentioning
confidence: 99%
“…31 Contrarily, a vertical LF tear is typically caused by a vertical laminar fracture due to axial compression and is not associated with other ligamentous injuries. 34 Interspinous Ligament. ISL is best evaluated using sagittal STIR or T2 image, which may show hyperintensity for both ISL edema and rupture.…”
Section: Ct Protocol and Imaging Considerationsmentioning
confidence: 99%
“…34 Furthermore, in addition to the morphological interpretation of CT findings, interpretation based on the presumed mechanism of injury is critical. 34,48 The distinction between HLF and VLF is a perfect example based on their may be time-consuming, which could explain the low reliability. As a result, focusing on the key PLC components and the most sensitive sequences is critical for developing a simple, yet efficient algorithm for MRI interpretation.…”
Section: Ct Criteria To Define Plc Injurymentioning
Study Design Systematic Literature Review. Objective To propose a systematic imaging algorithm for diagnosing posterior ligamentous complex (PLC) injury in computed tomography (CT) and magnetic resonance imaging (MRI) to improve the reliability of PLC assessment. Methods A systematic review was conducted following PRISMA guidelines. The Scopus database was searched from its inception until July 21, 2022, for studies evaluating CT or MRI assessment of the PLC injury following thoracolumbar trauma. The studies extracted key findings, objectives, injury definitions, and radiographic modalities. Results Twenty-three studies were included in this systematic review, encompassing 2021 patients. Five studies evaluated the accuracy of MRI in detecting thoracolumbar PLC injury using intraoperative findings as a reference. These studies indicate that black stripe discontinuity due to supraspinous or ligamentum flavum rupture is a more specific criterion of PLC injury than high-signal intensity. Thirteen papers evaluated the accuracy or reliability of CT in detecting thoracolumbar PLC injury using MRI or intraoperative findings as a reference. The overall accuracy rate of CT in detecting PLC injury was 68-90%. Two studies evaluate the accuracy of combined CT findings, showing that ≥2 CT findings are associated with a positive predictive value of 88-91 %. Vertebral translation, facet joint malalignment, spinous process fracture, horizontal laminar fracture, and interspinous widening were independent predictors of PLC injury. Conclusion We provided a comprehensive imaging algorithm for diagnosing PLC in CT and MRI based on available literature and our experience. The algorithm will potentially improve the accuracy and reliability of PLC assessment, however it needs multicentre prospective validation.
“…We looked for the following 4 CT signs independently associated with PLC injury: 16,15,23 (1) facet joint malalignment (FJM), (2) horizontal fracture of the lamina or pedicle (HLF), (4) avulsion or transverse fracture of the spinous process (SPF), and (5) interspinous distance widening (ISW) >4 mm. (Figure 4E-4H).…”
Study design retrospective study of consecutive patients Objective to analyze the frequency of change in Thoracolumbar fractures (TLFs) classification or decision-making after MRI compared by CT alone. Methods A retrospective review of 244 consecutive patients with acute TLFs (T1-L5) presented to a single level 1 trauma center between 2014 and 2021. Three and 4 reviewers independently classified all fractures according to AOSpine and AOSpine injury severity score (TLAOSIS) by CT then MRI, respectively. Posterior ligamentous complex Injury (PLC) was diagnosed on CT and MRI by ≥ 2 positive CT findings and Black stripe discontinuity. Results MRI changed AO classification in 25/244 patients (10.2%, P < .0001) due to an 8.2% upgrade from type A to type B and a 2% downgrade from type B to type A. The addition of MRI changed TL AOSIS among the 3 treatment recommendation groups in 35/244 (19.7%, 95% CI [14.9%-25.2%]. The best predictor of upgrade from type A to type B and downgrade from type B to type A was a single positive CT finding and the presence of only 2 CT signs as opposed to ≥3 signs, respectively ( P < .0001 P = .03, respectively). Thoracic fractures showed a significantly higher reclassification rate than thoracolumbar and low lumbar (20% vs 10% and 0%, respectively, P = .07). Conclusion using appropriate CT/MRI criteria for PLC injury, MRI changed the AOSpine classification by 10% and TLAOSIS based treatment by 19.7%. The best predictors of fracture reclassification by MRI were the number of positive CT findings and fracture level.
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