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Published on: November 8, 2024
Assessment of ligamentous injury in patients with thoracolumbar burst fractures using MRI
Li-Yang Dai1, Wen-Ge Ding, Xiang-Yang Wang
1Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. chinaspine@163.com
Background:
No consensus has been reached on the optimal radiographic evaluation of thoracolumbar burst fractures. The role of MRI in the treatment decision is not fully documented. The objectives was to measure the agreement of MRI in detecting posterior ligamentous complex (PLC) and posterior longitudinal ligament (PLL) injury, and to determine whether the findings by MRI is correlated with the results of plain radiography and computed tomography (CT) scanning as well as neurological examination and with the treatment planning.
Methods:
Sixty-one patients with acute thoracolumbar burst fracture were retrospectively reviewed for the presence of supraspinous ligament (SSL), interspinous ligament (ISL) or posterior longitudinal ligament (PLL) injury. The overall interobserver agreement between the three different observers was assessed by a kappa coefficient for multiple raters. The status of ligaments was correlated with the neurological function as assessed by Frankel scale and fracture severity as defined by the Load Sharing Classification. These patients were surgically treated according to the Load Sharing Classification and followed up for at least 5 years.
Results:
The kappa coefficients for ISL or SSL injury ranged 0.601 to 0.736, representing substantial to almost perfect agreement, whereas the kappa coefficients for PLL injury were 0.441 to 0.574, representing moderate agreement. No significant difference (P > 0.05) of Frankel scale or load sharing score was found between patients with and without ligamentous injuries. Satisfactory results were achieved in all patients regarding the clinical and radiological assessment.
Conclusions:
MRI is reliable for detecting the ligamentous injury, especially PLC injury in thoracolumbar burst fractures but the ligamentous injury as shown by MRI is not correlated with the neurological function or fracture severity. As MRI finding is of little value in treatment planning of thoracolumbar burst fractures, MRI examination is not necessary to be used routinely for excluding occult ligamentous injury.
Insights
Magnetic resonance imaging (MRI) reliably detects ligament injuries in thoracolumbar burst fractures. However, these MRI findings do not correlate with neurological function or fracture severity, making routine MRI unnecessary for treatment planning.
Area of Science:
- Orthopedic surgery
- Radiology
- Spinal trauma imaging
Background:
- Optimal radiographic evaluation for thoracolumbar burst fractures remains debated.
- The utility of MRI in guiding treatment decisions for these fractures is not well-established.
- Assessing MRI's accuracy in detecting posterior ligamentous complex (PLC) and posterior longitudinal ligament (PLL) injuries is crucial.
Purpose of the Study:
- To evaluate the interobserver agreement of MRI in detecting ligamentous injuries (SSL, ISL, PLL) in thoracolumbar burst fractures.
- To correlate MRI findings with neurological status (Frankel scale) and fracture severity (Load Sharing Classification).
- To determine the value of MRI findings in treatment planning for these fractures.
Main Methods:
- Retrospective review of 61 patients with acute thoracolumbar burst fractures.
- Assessment of supraspinous ligament (SSL), interspinous ligament (ISL), and posterior longitudinal ligament (PLL) injuries using MRI.
- Calculation of interobserver agreement using kappa coefficients.
- Correlation of ligamentous injury status with neurological function and fracture severity.
- Surgical treatment based on Load Sharing Classification and a minimum 5-year follow-up.
Main Results:
- Substantial to almost perfect agreement for ISL or SSL injury (kappa 0.601-0.736).
- Moderate agreement for PLL injury (kappa 0.441-0.574).
- No significant correlation found between ligamentous injuries and neurological function (Frankel scale) or fracture severity (Load Sharing Classification).
- All patients achieved satisfactory clinical and radiological outcomes.
Conclusions:
- MRI is reliable for detecting ligamentous injuries, particularly PLC injuries, in thoracolumbar burst fractures.
- Ligamentous injuries identified by MRI do not correlate with neurological deficits or fracture severity.
- Routine MRI is not essential for excluding occult ligamentous injury due to its limited value in treatment planning for thoracolumbar burst fractures.
