Abstract: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. Posteri… Show more
“…32 Detecting a ruptured SSL in the mid-thoracic area may be more challenging due to anatomical variations in the SSL/ISL complex. 6,26,33 Vascular marking due to a blood vessel crossing the black stripe should not be mistaken as black stripe discontinuity (Figure 5E). Figure 5.Magnetic resonance imaging findings in supraspinous ligament injury.…”
Section: Discussionmentioning
confidence: 99%
“…19,20 Only three studies have evaluated the interobserver reliability of detection, revealing moderate to perfect agreement (K = .39-.89, Table 1). 6,14,21…”
Section: Mri Accuracy or Reliability In Detection Of Plc Injurymentioning
confidence: 99%
“…1,5 MRI allows direct visualization of PLC structures with high sensitivity and is considered the reference study. 6 Conversely, CT can only detect secondary signs of PLC injury such as vertebral translation or facet diastasis and has a moderate accuracy (50-80 %) and reliability. 1,[7][8][9][10] Important logistical considerations are involved in comparing CT and MRI scans for PLC assessment.…”
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.
“…32 Detecting a ruptured SSL in the mid-thoracic area may be more challenging due to anatomical variations in the SSL/ISL complex. 6,26,33 Vascular marking due to a blood vessel crossing the black stripe should not be mistaken as black stripe discontinuity (Figure 5E). Figure 5.Magnetic resonance imaging findings in supraspinous ligament injury.…”
Section: Discussionmentioning
confidence: 99%
“…19,20 Only three studies have evaluated the interobserver reliability of detection, revealing moderate to perfect agreement (K = .39-.89, Table 1). 6,14,21…”
Section: Mri Accuracy or Reliability In Detection Of Plc Injurymentioning
confidence: 99%
“…1,5 MRI allows direct visualization of PLC structures with high sensitivity and is considered the reference study. 6 Conversely, CT can only detect secondary signs of PLC injury such as vertebral translation or facet diastasis and has a moderate accuracy (50-80 %) and reliability. 1,[7][8][9][10] Important logistical considerations are involved in comparing CT and MRI scans for PLC assessment.…”
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 have recently published the largest clinical series on the impact of MRI in thoracolumbar fracture classification in 244 neurologically intact patients. 4 We believe that our study provides an update on the prior systematic analysis because it provides a larger sample size, a higher level of evidence (level II), and a more robust methodology, as will be discussed later.MRI is frequently conducted for thoracolumbar fracture (TLF) patients with neurological deficits to assess cord injury, although it does not alter the decision between surgery and conservative treatment. On the other hand, patients with intact neurology undergo MRI to determine the posterior ligamentous complex (PLC) status and differentiate between AO type A and B.…”
mentioning
confidence: 85%
“…7 When analyzing the impact of MRI on fracture classification using these CT/MRI criteria, MRI had a far less influence on fracture classification than previously thought, changing the classification in just 10% of instances. 4 Furthermore, to help guide the indications of MRI in individual patients, we provided the rate of MRI reclassification for each fracture subtype depending on PLC status (injured, suspected, and intact). This analysis provided beneficial guidelines for indications of MRI for TLFs.…”
the Neurosurgery journal published a systematic analysis of radiological evaluation of thoracolumbar spine trauma. 1 Two of 2278 studies showed that adding a MRI scan in acute thoracolumbar trauma can significantly change the fracture classification or decision-making compared with computed tomography (CT) alone. 2,3 Unfortunately, these 2 studies provided only a level III evidence owing to the small sample size and heterogeneous or nonconsecutive patient population. We have recently published the largest clinical series on the impact of MRI in thoracolumbar fracture classification in 244 neurologically intact patients. 4 We believe that our study provides an update on the prior systematic analysis because it provides a larger sample size, a higher level of evidence (level II), and a more robust methodology, as will be discussed later.MRI is frequently conducted for thoracolumbar fracture (TLF) patients with neurological deficits to assess cord injury, although it does not alter the decision between surgery and conservative treatment. On the other hand, patients with intact neurology undergo MRI to determine the posterior ligamentous complex (PLC) status and differentiate between AO type A and B. Previous research comprised a mixed sample of TLFs with and without neurological deficits. 2,3 The fact that our study focused on patients with intact neurology removed bias may have been a critical strength. In addition, the large sample size and consecutive recruitment led to a well-balanced cohort regarding fracture types and mode of treatment. 5 Previous studies' analyses of the impact of MRI on TLFs' classification were hampered by using nonvalid CT/MRI criteria for PLC injury. 2,3 Previous studies identified PLC injury in MRI as a high-signal intensity despite the evidence indicating that black stripe discontinuity is a more specific criterion for diagnosing PLC damage. 6 To overcome this misclassification bias, we defined PLC injury in MRI as back stripe discontinuity due to supraspinous or ligamentum flavum. 7 We have previously shown that using highsignal intensity may reduce CT sensitivity for PLC injury from 91% to 66%. 7 Similarly, prior research defined PLC damage in CT as any positive CT finding of PLC injury, regardless of the variable or added predictive value of CT findings. We have shown that the following 4 CT findings are independent predictors for PLC injury: spinous process fracture, horizontal laminar fracture, facet diastasis, and interspinous widening >4 mm. 7 We proposed the following definition of PLC status in CT
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