Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma.
BACKGROUND
Posterior ligamentous complex (PLC), consisting of supraspinous ligament (SSL), interspinous ligament (ISL), ligamentum flavum (LF), and the facet joint capsules is thought to contribute significantly to the stability of thoracolumbar spine. Currently, no consensus exists on radiographic imaging parameters that may indicate injury to the posterior ligamentous complex.


OBJECTIVE
To identify imaging parameters that may suggest a disruption of the PLC of the thoracolumbar spine.


METHODS
A survey analysis of members of the Spine Trauma Study Group.


METHODS
None.


METHODS
Compilation of survey results.


METHODS
An extensive review of the literature from 1949 to the present was performed to identify key radiographic elements that have been suggested as indicators of PLC injury. Twelve items identified as such were placed on a survey and sent to the members of the Spine Trauma Study Group. They were asked to rank the items from most important to least important, and the results were compiled for analysis.


RESULTS
Twenty-eight surveys were returned for final analysis. Fifty-percent (14/28) of the members ranked "vertebral body translation" on plain radiographs as the most important factor in determining disruption of PLC. Plain radiographic signs were ranked higher than computed tomography or magnetic resonance imaging indicators, and history of the mechanism ranked lowest. The members were also given freedom to add other criteria that they felt were important in determining PLC integrity. "Interspinous spacing 7 mm greater than that of level above or below on antero posterior plain X-rays" was the only new category that was suggested.


CONCLUSIONS
Plain radiographic findings were felt to be most helpful in determining PLC injury by the members of the Spine Trauma Study Group. Physical examination findings and history of the mechanism of injury were ranked lower than imaging studies. Future analysis should focus on indicators of PLC injury when plain radiographic findings are either subtle or not present.
Vaccaro
Alexander R
AR
Thomas Jefferson University and The Rothman Institute, Philadelphia, PA, USA.
Lee
Joon Y
JY
Schweitzer
Karl M
KM
Lim
Moe R
MR
Baron
Eli M
EM
Oner
F C
FC
Hulbert
R John
RJ
Hedlund
Rune
R
Fehlings
Michael G
MG
Arnold
Paul
P
Harrop
James
J
Bono
Christopher M
CM
Anderson
Paul A
PA
Anderson
D Greg
DG
Harris
Mitchel B
MB
D032921:Consensus; D003625:Data Collection; D006801:Humans; D015601:Injury Severity Score; D017843:Ligamentum Flavum / Q000293:injuries*; D017846:Longitudinal Ligaments / Q000293:injuries*; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology*; D013124:Spinal Injuries / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000293:injuries / Q000473:pathology*; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000503:physiopathology