Prediction of posterior ligamentous complex injury in thoracolumbar fractures using non-MRI imaging techniques

Rajasekaran, Shanmuganathan; Maheswaran, Anupama; Aiyer, Siddharth N.; Kanna, Rishi Mugesh; Dumpa, Srikanth Reddy; Shetty, Ajoy Prasad

doi:10.1007/s00264-016-3151-1

Cited by 25 publications

(20 citation statements)

References 27 publications

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“…Hiyama et al 24 assessed loss of vertebral body height, local kyphosis, vertebral body translation, canal compromise, interlaminar distance, supraspinous distance, and interspinous distance in 40 patients with TL fractures and concluded that a local kyphosis >20° and increased supraspinous distance were associated with PLC injury. Rajasekaran et al 25 analyzed 60 patients with possible PLC injury using STIR MRI sequences as a gold standard to identify PLC injury. The authors reported that local kyphosis of >20° and interspinous distance increase of ≥2 mm compared with adjacent levels may serve as a radiological criterion to predict PLC injury, especially in the scenario of emergency trauma where MRI is not feasible.…”

Section: Discussionmentioning

confidence: 99%

“…16,22,23 A number of authors have suggested to identify PLC injury on CT scans, based on criteria such as facet diastasis, local kyphosis, and interspinous distance. 12,[24][25][26][27][28] The possibility to accurately identify PLC injury on CT scans would prove to be a great advantage, thus expediting treatment of TL fractures without MRI, especially in the clinical scenario of polytrauma with an unstable patient. 23 Although reports have suggested that CT-based radiological parameters may reliably detect PLC injury.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Interobserver Variability for CT Scan–Based Evaluation of Posterior Ligament Complex Injury in Thoracolumbar Fractures: An International Multicenter Pilot Study

Maheswaran

Aiyer

Farouk

et al. 2019

Global Spine Journal

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Study Design: A multicenter, pilot study, for radiological assessment of thoracolumbar spine fractures was performed with the participation of 7 centers in Africa, Europe, Asia, and South America as a part of the AO Foundation network. Objectives: To determine the interobserver variability for computed tomography (CT) scan–based evaluation of posterior ligament complex (PLC) injury in thoracolumbar fractures. Methods: Forty-two observers including 1 principal investigator at each participating center performed variability assessment. Each center contributed toward a total of 91 patient images with A3 or A4 thoracolumbar burst fractures (T11-L2) with or without suspected PLC injury. Pathological fractures, multilevel injuries, obvious posterior bony element injury and translation/dislocation injuries were excluded. Ten patients were randomly selected and commonly reported CT parameters indicating PLC injury, including superior inferior endplate angle, vertebral body height loss, local kyphotic deformity, interspinous distance and interpedicular distance were assessed for variability. Observer values were compared with an experienced gold rater in spinal trauma. Analysis of variability was performed for all observers, between the principal investigators and also between observers participating in each center. Results: The studied parameters showed considerable variability in measurements among all observers and amongst all participating centers. The variability between the principal investigators was lower, but still substantial. The deviation of observer measurements from the gold rater were also significant for all CT parameters. Conclusions: CT-based radiological parameters previously reported to be suggestive of PLC injury showed considerable variability and magnetic resonance imaging verification of a PLC injury in all doubtful cases is suggested.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Interobserver Variability for CT Scan–Based Evaluation of Posterior Ligament Complex Injury in Thoracolumbar Fractures: An International Multicenter Pilot Study

Maheswaran

Aiyer

Farouk

et al. 2019

Global Spine Journal

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“…Historically, many classify spine fractures utilizing general mechanical or morphological criteria, and using the CT scan as a tool for imaging-based diagnosis. [ 1 4 ] However, here, we utilized the MRI and the “gap” sign involving the ruptured LF to identify spinal fractures that were original missed.…”

Section: Discussionmentioning

confidence: 99%

“…At this point, delayed evidence of instability may develop, and kyphosis (angle ≥10°), loss of vertebral height (≥50%), translation (X-rays >3.5 mm), and further fixed kyphosis can be found. [ 4 6 ]…”

Section: Introductionmentioning

confidence: 99%

Using the “ligamentum flavum gap” to identify originally missed type B vertebral fractures

Guiroy¹,

Carlos²,

Picard³

et al. 2018

Surg Neurol Int

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Background:Spine fractures may involve the ligamentum flavum (LF). Here, we utilized the “ligamentum flavum gap,” defined by the discontinuity of the LF at the level of a vertebral fracture, to document a vertebral fracture.Methods:Utilizing X-rays, computed tomography (CT), and magnetic resonance (MR) studies, 10 patients with type B vertebral fractures were diagnosed with the ligamentum flavum gap (LFG: discontinuity of the LF) at the fracture levels. The fractures were located in 2 patients in the cervical and 8 in the thoracolumbar spine.Results:All 10 patients with vertebral fractures had complained of axial pain. Four also showed progressive thoracic kyphosis. Notably, all demonstrated a loss of continuity in the LF at the level of fracture “ligamentum flavum gap.” T2-weighted and short tau inversion recovery (STIR) MR sagittal studies were best at locating LFG at the level of a fracture.Conclusion:Here, we identified best on sagittal T2 and STIR-weighted MR studies 10 patients for whom discontinuity of the ligamentum flavum (LFG) correlated with the location of type B vertebral fractures.

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“…It is, however extremely useful in nerve root compression. It is also very useful in trauma [15]. There has been and equally encouraging advance in the so called 'percutaneous' techniques [16].…”

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confidence: 99%

Spinal Special Edition Editorial

Quaile

2016

International Orthopaedics (SICOT)

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Prediction of posterior ligamentous complex injury in thoracolumbar fractures using non-MRI imaging techniques

Cited by 25 publications

References 27 publications

Assessment of Interobserver Variability for CT Scan–Based Evaluation of Posterior Ligament Complex Injury in Thoracolumbar Fractures: An International Multicenter Pilot Study

Assessment of Interobserver Variability for CT Scan–Based Evaluation of Posterior Ligament Complex Injury in Thoracolumbar Fractures: An International Multicenter Pilot Study

Using the “ligamentum flavum gap” to identify originally missed type B vertebral fractures

Spinal Special Edition Editorial

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