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


BACKGROUND
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.


CONCLUSIONS
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.
Vaccaro
Alexander R
AR
The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. alexvaccaro3@aol.com
Rihn
Jeffrey A
JA
Saravanja
Davor
D
Anderson
David G
DG
Hilibrand
Alan S
AS
Albert
Todd J
TJ
Fehlings
Michael G
MG
Morrison
William
W
Flanders
Adam E
AE
France
John C
JC
Arnold
Paul
P
Anderson
Paul A
PA
Friel
Brian
B
Malfair
David
D
Street
John
J
Kwon
Brian
B
Paquette
Scott
S
Boyd
Michael
M
Dvorak
Marcel F S
MF
Fisher
Charles
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017843:Ligamentum Flavum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D017846:Longitudinal Ligaments / Q000293:injuries* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D021801:Zygapophyseal Joint / Q000293:injuries* / Q000601:surgery