title: Reliability of the evaluation of posterior ligamentous complex injury in thoracolumbar spine trauma with the use of computed tomography scan.
abstract: OBJECTIVE
  The AOSpine thoracolumbar (TL) spine injury classification system is based mainly on computed tomography (CT). The main purpose of this study was to evaluate the reliability of CT scan in the diagnosis of posterior ligamentous complex (PLC) injury in thoracolumbar spine trauma (TLST).
  
  
  METHODS
  We performed a cross-sectional study of 43 patients with TLST. CT scans were evaluated independently by three spine surgeons on two separate occasions, 2 months apart. The reliability of PLC injury parameters was assessed by the Kappa coefficient (κ) and the average percentage of these parameters was established. Injuries were classified according to the AOSpine classification as type A (compression), B (anterior and/or posterior tension band injuries) or C (dislocation) injury and the reliability of the classification was calculated.
  
  
  RESULTS
  On average, PLC injury was identified in 91.4% of type B or C injuries. Tension band injury and dislocation were found in 90.5% of type B and 93.2% of type C injuries. The intraobserver reliability for the PLC injury parameters ranged from 0.518 to 1.000, except for increased interspinous distance (IID). Interobserver reliability ranged from 0.303 to 0.688. When the patients were evaluated as a whole, dislocation showed the highest κ (0.656 and 0.688). When type A or B injuries were assessed, the highest κ were found for IID (0.533 and 0.511) and tension band injury (0.486 and 0.452). The κ for AOSpine classification was 0.526 and 0.645 in both assessments.
  
  
  CONCLUSIONS
  In this study, the use of CT scan as the only diagnostic tool could identify PLC injury in most cases and demonstrated satisfactory reliability. Dislocation could satisfactorily diagnose type C injury, while IID was the best parameter to differentiate between type A and B injuries.
authors.affiliation: Neurosurgery Division, Hospital Estadual de Emergência e Trauma Senador Humberto Lucena, Avenida Esperança, Avenida Orestes Lisboa S/N, Bairro Pedro Gondim, João Pessoa, 58031090, Paraíba, Brazil. aleciobarcelos.ineuro@gmail.com.|Post-graduation Program in Health Sciences, IAMSPE, Av. Ibirapuera, 981 - 2º andar Vila Clementino, São Paulo, 04029-000, São Paulo, Brazil. aleciobarcelos.ineuro@gmail.com.|, Avenida Esperança, n. 1140, ap 1301, Bairro Manaíra, João Pessoa, 58038281, Paraíba, Brazil. aleciobarcelos.ineuro@gmail.com.
authors.forename: Alecio Cristino Evangelista Santos
authors.identifier: http://orcid.org/0000-0002-2268-2327
authors.initials: AC
authors.lastname: Barcelos
authors.affiliation: Department of Neurology, University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil.|Post-graduation Program in Health Sciences, IAMSPE, Av. Ibirapuera, 981 - 2º andar Vila Clementino, São Paulo, 04029-000, São Paulo, Brazil.
authors.forename: Andrei Fernandes
authors.initials: AF
authors.lastname: Joaquim
authors.affiliation: Neurosurgery Division, Hospital do Servidor Público Estadual de São Paulo, Av. Ibirapuera, 981, Indianópolis, São Paulo, SP, Brazil.|Post-graduation Program in Health Sciences, IAMSPE, Av. Ibirapuera, 981 - 2º andar Vila Clementino, São Paulo, 04029-000, São Paulo, Brazil.
authors.forename: Ricardo Vieira
authors.initials: RV
authors.lastname: Botelho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Computed tomography; Longitudinal ligaments; Posterior ligamentous complex; Reliability; Spinal fractures
references.citation: J Spinal Disord Tech. 2005 Jun;18(3):209-15
references.pmid: 15905761
references.citation: Spine (Phila Pa 1976). 2006 May 15;31(11 Suppl):S62-9; discussion S104
references.pmid: 16685239
references.citation: Spine (Phila Pa 1976). 2004 Mar 1;29(5):564-7
references.pmid: 15129074
references.citation: J Orthop Sci. 2007 Sep;12 (5):437-42
references.pmid: 17909928
references.citation: J Craniovertebr Junction Spine. 2013 Jan;4(1):25-31
references.pmid: 24381453
references.citation: Spine (Phila Pa 1976). 2009 Nov 1;34(23 ):E841-7
references.pmid: 19927090
references.citation: Mod Rheumatol. 2013 Sep;23(5):1008-12
references.pmid: 22821421
references.citation: J Neurosurg Spine. 2010 Apr;12(4):391-6
references.pmid: 20367374
references.citation: Spine (Phila Pa 1976). 2006 Dec 1;31(25):2963-6
references.pmid: 17139228
references.citation: Eur Spine J. 2015 Apr;24(4):864-70
references.pmid: 25281332
references.citation: Eur Spine J. 2012 Nov;21(11):2222-31
references.pmid: 22722921
references.citation: Spine (Phila Pa 1976). 2007 Apr 1;32(7):791-5
references.pmid: 17414915
references.citation: J Bone Joint Surg Am. 1983 Apr;65(4):461-73
references.pmid: 6833320
references.citation: J Neurosurg Spine. 2006 Feb;4(2):118-22
references.pmid: 16506478
references.citation: J Neurosurg. 2003 Jul;99(1 Suppl):20-6
references.pmid: 12859054
references.citation: Spine (Phila Pa 1976). 1982 Jul-Aug;7(4):365-73
references.pmid: 7135069
references.citation: World J Emerg Surg. 2007 Sep 07;2:24
references.pmid: 17825106
references.citation: Spine (Phila Pa 1976). 2015 Dec;40(23):E1250-6
references.pmid: 26165219
references.citation: J Trauma. 2009 Jun;66(6):1610-5
references.pmid: 19509622
references.citation: Med Hypotheses. 2013 Jul;81(1):117-8
references.pmid: 23639281
references.citation: Spine (Phila Pa 1976). 2013 Nov 1;38(23 ):2028-37
references.pmid: 23970107
references.citation: AJNR Am J Neuroradiol. 2003 Mar;24(3):366-9
references.pmid: 12637283
references.citation: Eur J Pediatr. 2006 Apr;165(4):278-9
references.pmid: 16320071
references.citation: Spine (Phila Pa 1976). 2012 May 15;37(11):E662-7
references.pmid: 22146288
references.citation: J Bone Joint Surg Am. 1970 Dec;52(8):1534-51
references.pmid: 5483077
references.citation: Asian Spine J. 2010 Dec;4(2):109-17
references.pmid: 21165314
references.citation: J Bone Miner Res. 2003 Jan;18(1):24-9
references.pmid: 12510802
references.citation: Spine (Phila Pa 1976). 2015 Apr 15;40(8):E498-503
references.pmid: 25868104
references.citation: J Spinal Disord. 1998 Aug;11(4):346-9
references.pmid: 9726306
references.citation: J Spinal Cord Med. 2004;27(5):481-3
references.pmid: 15648804
references.citation: J Int Med Res. 2013 Aug;41(4):1252-7
references.pmid: 23760913
references.citation: Spine (Phila Pa 1976). 1994 Aug 1;19(15):1731-40
references.pmid: 7973968
references.citation: Spinal Cord. 1997 May;35(5):266-74
references.pmid: 9160449
references.citation: Spine (Phila Pa 1976). 2002 Mar 15;27(6):629-36
references.pmid: 11884911
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571
references.citation: Eur Spine J. 2004 Mar;13(2):101-7
references.pmid: 14615927
references.citation: Spine (Phila Pa 1976). 2005 Oct 15;30(20):2325-33
references.pmid: 16227897
references.citation: Spine (Phila Pa 1976). 2007 Feb 1;32(3):E105-10
references.pmid: 17268253
references.citation: Eur Spine J. 2013 Mar;22(3):461-74
references.pmid: 23208081
references.citation: Am J Emerg Med. 2007 Jan;25(1):69-71
references.pmid: 17157687