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01-11-2012 | Original Article

MRI study of post-traumatic incompetence of posterior ligamentous complex: importance of the supraspinous ligament. Prospective study of 74 traumatic fractures

Authors: Javier Pizones, Lorenzo Zúñiga, Felisa Sánchez-Mariscal, Patricia Álvarez, Alejandro Gómez-Rice, Enrique Izquierdo

Published in: European Spine Journal | Issue 11/2012

Abstract

Purpose

Posterior ligamentous complex (PLC) components have an orderly sequence of rupture. However, it is still unclear how many structures have to be damaged to consider it disrupted. We aim to establish imaging criteria, which can define the complex as competent or incompetent.

Methods

Prospective study of 74 consecutive vertebral acute traumatic fractures, using X-rays and MRI scan (FS-T2-w/STIR sequences). We analyzed the association between MRI signal (intact, edema, disruption) of each PLC component—facet capsules (FC), interspinous ligaments (ISL), supraspinous ligaments (SSL) and ligamentum flavum (LF)—and the variables: AO/TLICS classification, treatment, surgical findings, interspinous diastasis index (IDI), local kyphosis (LVK) and ISS (TLICS) score. χ² test and U Mann–Whitney were used for statistics.

Results

MR images of ISL edema correlated surgically with intact ligaments or laxity, and were associated with 87.5 % of facet distraction, LVK: 11.6º, IDI: 1.2. Images of ISL, SSL or LF disruptions showed in all cases ruptures under surgical examination. Images of SSL disruption associated with LVK: 14.5º, IDI: 1.8. Images of ISL disruption associated with SSL/LF rupture, LVK: 16º, and IDI: 2; while LF disruption showed LVK: 18º, IDI: 1.9.

When comparing “competent PLC” (images of facet distraction and ISL edema) with “incompetent PLC” (images of SSL disruption ± ISL or LF disruption) the latest showed more severe scores in every variable (p < 0.001), except neurologic status.

Conclusion

Following PLC rupture sequence, ISL edema with facet distraction seems not to be enough to define a posterior tension band incompetence. It is the further step of SSL rupture what gives the key to PLC incompetence.

Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201PubMedCrossRef

Parizel PM, van der Zijden T, Gaudino S, Spaepen M, Voormolen MHJ, Venstermans C, De Belder F, van den Hauwe L, Van Goethem J (2010) Trauma of the spine and spinal cord: imaging strategies. Eur Spine J 19:S8–S17PubMedCrossRef

Bagley LJ (2006) Imaging of spinal trauma. Radiol Clin North Am 44:1–12PubMedCrossRef

Vaccaro AR, Rihn JA, Saravanja D et al (2009) Injury of the posterior ligamentous complex of the thoracolumbar spine a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine 34:E841–E847PubMedCrossRef

Vaccaro AR, Lee JY, Schweitzer KM et al (2006) Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J 6:524–528PubMedCrossRef

Lee HM, Kim HS, Kim DJ et al (2000) Reliability of magnetic resonance imaging in detecting posterior complex injury in thoracolumbar spinal fractures. Spine 25:2079–2084PubMedCrossRef

Öner FC, Ramos LMP, Simmermacher RKJ, Kingma PTD, Diekerhof CH, Dhert WJA, Verbout AJ (2002) Classification of thoracic and lumbar spine fractures: problems of reproducibility. A study of 53 patients using CT and MRI. Eur Spine J 11:235–245PubMedCrossRef

Emery SE, Pathria MN, Wilber RG, Masaryk T, Bohlman HH (1989) Magnetic resonance imaging of posttraumatic spinal ligament injury. J Spinal Disord 2:229–233PubMedCrossRef

Terk MR, Hume-Neal M, Fraipont M, Ahmadi J, Colletti PM (1997) Injury of the posterior ligament complex in patients with acute spinal trauma: evaluation by MR imaging. Am J Roentgenol 168:1481–1486

10.

Pizones J, Izquierdo E, Sánchez-Mariscal F, Zúñiga L, Álvarez P, Gómez-Rice A (2012) Sequential damage assessment of the different components of the posterior ligamentous complex after magnetic resonance imaging interpretation. Prospective study 74 traumatic fractures. Spine 37(11):E662–E667

11.

Vaccaro AR, Zeiller SC, Hurlbert RJ et al (2005) The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech 18:209–215PubMed

12.

Vaccaro AR, Lehman RA Jr, Hurlbert RJ et al (2005) A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 30:2325–2333PubMedCrossRef

13.

Pizones J, Izquierdo E, Sánchez-Mariscal F, Álvarez P, Zúñiga L (2010) Comment on the paper: Vaccaro AR, Rihn JA, Saravanja D, et al. Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine 35:929–930PubMedCrossRef

14.

Rihn JA, Fisher C, Harrop J, Morrison W, Yang N, Vaccaro RA (2010) Assessment of the posterior ligamentous complex following acute cervical spine trauma. J Bone Joint Surg Am 92:583–589PubMedCrossRef

15.

Lee JY, Vaccaro AR, Schweitzer KM et al (2007) Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiograph. Spine J 7:422–427PubMedCrossRef

16.

White AA III, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. JB Lippincott, Philadelphia

17.

James KS, Wenger KH, Schlegel JD et al (1994) Biomechanical evaluation of the stability of thoracolumbar burst fractures. Spine 19:1731–1740PubMedCrossRef

18.

Öner FC, van Gils APG, Faber JAJ, Dhert JA, Verbout AJ (2002) Some complications of common treatment schemes of thoracolumbar spine fractures can be predicted with magnetic resonance imaging. Prospective study of 53 patients with 71 fractures. Spine 27:629–636PubMedCrossRef

19.

Daffner RH, Deeb ZL, Goldberg AL et al (1990) The radiologic assessment of post-traumatic vertebral stability. Skeletal Radiol 19:103–108PubMed

20.

Nagel DA, Koogle TA, Piziali RL et al (1981) Stability of the upper lumbar spine following progressive disruptions and the application of individual internal and external fixation devices. J Bone Joint Surg Am 63:62–70PubMed

21.

Öner FC, van der Rijt R, Ramos LMP et al (1999) Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures. Eur Spine J 8:194–198PubMedCrossRef

Title: MRI study of post-traumatic incompetence of posterior ligamentous complex: importance of the supraspinous ligament. Prospective study of 74 traumatic fractures
Authors: Javier Pizones
Lorenzo Zúñiga
Felisa Sánchez-Mariscal
Patricia Álvarez
Alejandro Gómez-Rice
Enrique Izquierdo
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 11/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2403-z

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Springer Medicine

MRI study of post-traumatic incompetence of posterior ligamentous complex: importance of the supraspinous ligament. Prospective study of 74 traumatic fractures

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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