Predictive Value of Computed Tomography Scan for Posterior Ligamentous Complex Injuries in Patients with Thoracolumbar Spinal Fractures

Document Type : RESEARCH PAPER

Authors

1 Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Neurosurgery, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Neurosurgery, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Thoracolumbar spinal fractures include a range of injuries of various severities from simple apophyseal
fractures to neurological injury and complex fractures associated with vertebral dislocation. The treatment of
thoracolumbar fractures is challenging, especially due to the difficulty of evaluating the posterior ligamentous complex
(PLC). The purpose of this study was to evaluate the diagnostic value of computed tomography (CT) scan in predicting
PLC injuries in the patients with thoracolumbar spinal fractures referring to the referral center of spinal trauma in the
east north of Iran in 2016.
Methods: This retrospective study was conducted on patients with thoracolumbar injuries referring to Shahid Kamyab
Hospital in Mashhad, east north of Iran, in 2016. The data were collected by entering the data of medical records into
special forms. The classification of spinal fractures was accomplished using the AO Spine Classification System.
Results: According to the results, 71 (71.7%) patients were male, and the subjects had a mean age of 44.6±17.7 years.
The PLC injury was observed in 28 (28.3%) patients. The PLC injury showed a significant relationship with facet joint
widening, increased interspinous process distance, and spinous process avulsion fracture (P<0.05).
Conclusion: As the findings of this study indicated, the diagnostic results of PLC injury by means of CT scan was
similar to those obtained by magnetic resonance imaging in patients with thoracolumbar spinal fractures.
Level of evidence: III

Keywords

Main Subjects


1. Heinzelmann M, Wanner GA. Spinal Disorders.
Thoracolumbar spinal injuries. New Delhi: Springer;
2008.
2. Rihn JA, Yang N, Fisher C, Saravanja D, Smith H,
Morrison WB, Harrop J, Vacaro AR. Using magnetic
resonance imaging to accurately assess injury to
the posterior ligamentous complex of the spine:
a prospective comparison of the surgeon and
radiologist. Journal of Neurosurgery: Spine. 2010
Apr;12(4):391-6.
3. Taghippor M, Sherafat Kazemzadeh E. Column and
Spinal Cord Injuries in Shiraz Nemazi Hospital,
an Epidemiological Study. Armaghane danesh.
2006;10(4):55-62.
4. Fakharian E, Tabesh H, Masoud S. An epidemiologic
study on spinal injuries in Kashan. Journal of Guilan
University of Medical Sciences. 2004;13(49):80-5.
5. Sixta S, Moore FO, Ditillo MF, Fox AD, Garcia AJ, Holena
D, et al. Screening for thoracolumbar spinal injuries in
blunt trauma: an Eastern Association for the Surgery
of Trauma practice management guideline. Journal of
Trauma and Acute Care Surgery. 2012;73(5):S326S32.
6. Barcelos ACES, Joaquim AF, Botelho RV. Reliability of
the evaluation of PLC injury in thoracolumbar spine
trauma with the use of computed tomography scan.
European Spine Journal. 2016;25(4):1135-43.
7. Lee H-M, Kim H-S, Kim D-J, Suk K-S, Park J-O, Kim N-H.
Reliability of magnetic resonance imaging in detecting
posterior ligament complex injury in thoracolumbar
spinal fractures. Spine. 2000;25(16):2079-84.
8. Vaccaro AR, Lehman Jr RA, Hurlbert RJ, Anderson
PA, Harris M, Hedlund R, et al. A new classification
of thoracolumbar injuries: the importance of
injury morphology, the integrity of the posterior
ligamentous complex, and neurologic status. Spine.
2005;30(20):2325-33.
9. Vaccaro AR, Lim MR, Hurlbert RJ, Lehman Jr RA,
Harrop J, Fisher DC, et al. Surgical decision making
for unstable thoracolumbar spine injuries: results of
a consensus panel review by the Spine Trauma Study
Group. Clinical Spine Surgery. 2006;19(1):1-10.
10. Winn HR. Youmans neurological surgery. Philadelphia:
Elsevier/Saunders; 2017.
11. Aebi M. AO spine classification system for
thoracolumbar fractures.
12. White AA, Panjabi MM. Clinical biomechanics of the
spine: Lippincott Philadelphia; 1990.
13. Dahdaleh NS, Viljoen SV, Dalm BD, Howard MA,
Grosland NM. Posterior ligamentous complex healing
following disruption in thoracolumbar fractures.
Medical hypotheses. 2013;81(1):117-8.
14. Pizones J, Izquierdo E, Sánchez-Mariscal F, Zúñiga
L, Á􀆵 lvarez P, Gómez-Rice A. Sequential damage
assessment of the different components of the
posterior ligamentous complex after magnetic
resonance imaging interpretation: prospective study
74 traumatic fractures. Spine. 2012;37(11):E662-E7.
15. van Middendorp JJ, Patel AA, Schuetz M, Joaquim
AF. The precision, accuracy and validity of detecting
posterior ligamentous complex injuries of the thoracic
and lumbar spine: a critical appraisal of the literature.
European Spine Journal. 2013;22(3):461-74.
16. Haba H, Taneichi H, Kotani Y, Terae S, Abe S, Yoshikawa
H, et al. Diagnostic accuracy of magnetic resonance
imaging for detecting posterior ligamentous complex
injury associated with thoracic and lumbar fractures.
Journal of Neurosurgery: Spine. 2003 Jul;99(1):20-6.
17. Vaccaro AR, Rihn JA, Saravanja D, Anderson DG,
Hilibrand AS, Albert TJ, et al. Injury of the posterior
ligamentous complex of the thoracolumbar
spine: a prospective evaluation of the diagnostic
accuracy of magnetic resonance imaging. Spine.
2009;34(23):E841-7.