Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications

Abstract

The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management.Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries.In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.

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The Importance of Orthostatic Radiography in the Management of Thoracolumbar Fractures: Case Report

“…The diagnosis can be achieved using indirect signs of spinal radiographs and CT when the cuts are thinner (1-2 mm) with splaying of the spinous processes, avulsion of the superior or inferior margins of the spinous processes, widened facet joints, empty ("naked") facet joints, perched/dislocated facet joints, and vertebral translation/ rotation, or with direct view of PLC injury using MRI. 4,12,13 The use of the simple plain radiographies in the orthostatic position may be useful to obtain additional information for the evaluation of stability, especially at the level of controversial fractures. 14,15 Current trauma protocols are based in radiographs and decubitus CT scans that limit the visualization of soft tissues; therefore, PLC injuries may not be detected.…”

Evaluation and Management of Thoracolumbar Spine Trauma in Pediatric Patients

“…Within the posterior column exists the most important of the soft-tissue stabilizers of the spine, the posterior ligamentous complex (PLC), which consists of 4 main components: the supraspinous ligament, the interspinous ligament, the articular facet joint capsule, and the ligamentum flavum. The PLC forms a posterior tension band for the spine and limits flexion, axial rotation, and distraction of the spine 5 .…”