title: Diagnostic accuracy of ultrasound for detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: A systematic review and meta-analysis.
abstract: BACKGROUND
  Posterior ligamentous complex injuries of the thoracolumbar (TL) spine represent a major consideration during surgical decision-making. However, X-ray and computed tomography imaging often does not identify those injuries and sometimes magnetic resonance imaging (MRI) is not available or is contraindicated.
  
  
  OBJECTIVE
  To determine the diagnostic accuracy of the ultrasound for detecting posterior ligamentous complex injuries in the TL spine.
  
  
  METHODS
  A systematic review was carried out through four international databases and proceedings of scientific meetings. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and their 95% confidence intervals (CIs) were estimated, by using weighted averages according to the sample size of each study. Summary receiver operating characteristic was also estimated.
  
  
  RESULTS
  A total of four articles were included in the meta-analysis, yielding a summary estimate: Sensitivity, 0.89 (95% CI, 0.86-0.92); specificity, 1.00 (95% CI, 0.98-1.00); positive likelihood ratio, 224.49 (95% CI, 30.43-1656.26); negative likelihood ratio, 0.11 (95% CI, 0.05-0.19); and diagnostic odds ratio, 2,268.13 (95% CI, 265.84-19,351.24). There was no statistically significant heterogeneity among results of included studies.
  
  
  CONCLUSIONS
  Receiver operating characteristic (±standard error) was 0.928 ± 0.047.
  
  
  CONCLUSIONS
  The present meta-analysis showed that ultrasound has a high accuracy for diagnosing posterior ligamentous complex injuries in patients with flexion distraction, compression, or burst TL fractures. On the basis of present results, ultrasound may be considered as a useful alternative when magnetic resonance imaging (MRI) is unavailable or contraindicated, or when its results are inconclusive.
authors.affiliation: Department of Neurological Research, Health Sciences and Neurosciences (CISNEURO) Research Group, University of Cartagena, Cartagena de Indias, Colombia ; Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia.
authors.forename: Alcalá-Cerra
authors.initials: AC
authors.lastname: Gabriel
authors.affiliation: Department of Neurological Research, Health Sciences and Neurosciences (CISNEURO) Research Group, University of Cartagena, Cartagena de Indias, Colombia.
authors.forename: J Paternina-Caicedo
authors.initials: JP
authors.lastname: Angel
authors.affiliation: Department of Neurological Research, Health Sciences and Neurosciences (CISNEURO) Research Group, University of Cartagena, Cartagena de Indias, Colombia.
authors.forename: J Gutiérrez-Paternina
authors.initials: JG
authors.lastname: Juan
authors.affiliation: Department of Neurological Research, Health Sciences and Neurosciences (CISNEURO) Research Group, University of Cartagena, Cartagena de Indias, Colombia.
authors.forename: R Moscote-Salazar
authors.initials: RM
authors.lastname: Luis
authors.affiliation: Department of Neurological Research, Health Sciences and Neurosciences (CISNEURO) Research Group, University of Cartagena, Cartagena de Indias, Colombia.
authors.forename: R Alvis-Miranda
authors.initials: RA
authors.lastname: Hernando
authors.affiliation: Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia.
authors.forename: Sabogal-Barrios
authors.initials: SB
authors.lastname: Rubén
keywords: Burst fracture; instability; posterior ligamentous complex; ultrasound