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Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging.

Abstract：

STUDY DESIGN:Prospective diagnostic imaging study. OBJECTIVE:To determine the accuracy of magnetic resonance imaging (MRI) in diagnosing injury of the posterior ligamentous complex (PLC) in patients with thoracolumbar trauma. SUMMARY OF BACKGROUND DATA:Treatment decisions in thoracolumbar injury patients are currently based on the status of the PLC. It is, therefore, important to understand the accuracy of MRI in diagnosing varying degrees of PLC injury. Prior studies report that MRI is up to 100% sensitive for diagnosing PCL injury. METHODS:Patients with an acute injury from T1 to L3 who required posterior surgery were prospectively studied. A musculoskeletal radiologist, based on the preoperative MRI findings, characterized each of the 6 components of the PLC as intact, incompletely disrupted, or disrupted. During the surgical procedure, the surgeon identified each component of the PLC as intact, incompletely disrupted, or disrupted. The radiologist's interpretation and surgical findings were compared. RESULTS:Forty-two patients with 62 levels of injury were studied. There were 33 males (78.6%) and 9 females (21.4%), and the average age was 35.7 years. According to the kappa score, there was a moderate level of agreement between the radiologist's interpretation and the intraoperative findings for all PLC components except the thoracolumbar fascia, for which there was slight agreement. The sensitivity for the various PLC components ranged from 79% (left facet capsule) to 90% (interspinous ligament). The specificity ranged from 53% (thoracolumbar fascia) to 65% (ligamentum flavum). There was less agreement between the radiologist and surgeon for the patients with less severe neurologic compromise, i.e., those patients with an AIS grade of either D or E. CONCLUSION:The sensitivity and specificity of MRI for diagnosing injury of the PLC are lower than previously reported in the literature. The integrity of the PLC as determined by MRI should not be used in isolation to determine treatment.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Vaccaro AR,Rihn JA,Saravanja D,Anderson DG,Hilibrand AS,Albert TJ,Fehlings MG,Morrison W,Flanders AE,France JC,Arnold P,Anderson PA,Friel B,Malfair D,Street J,Kwon B,Paquette S,Boyd M,Dvorak MF,Fisher C

doi

10.1097/BRS.0b013e3181bd11be

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

E841-7

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-200911010-00028

journal_volume

pub_type

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Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging.