Yonsei Med J.  2013 Jul;54(4):1020-1025. 10.3349/ymj.2013.54.4.1020.

Posterior Ligamentous Complex Injuries Are Related to Fracture Severity and Neurological Damage in Patients with Acute Thoracic and Lumbar Burst Fractures

• Machino M
• Yukawa Y
• Ito K
• Kanbara S
• Morita D
• Kato F

• KMID: 2158240
• DOI: http://doi.org/10.3349/ymj.2013.54.4.1020

Abstract

PURPOSE
The proposed the thoracolumbar injury classification system (TLICS) for thoracolumbar injury cites the integrity of the posterior ligamentous complex (PLC). However, no report has elucidated the severity of damage in thoracic and lumbar injury with classification schemes by presence of the PLC injury. The purpose of this study was to accurately assess the severity of damage in thoracic and lumbar burst fractures with the PLC injuries.
MATERIALS AND METHODS
One hundred consecutive patients treated surgically for thoracic and lumbar burst fractures were enrolled in this study. There were 71 men and 29 women whose mean age was 36 years. Clinical and radiologic data were investigated, and the thoracolumbar injury classification schemes were also evaluated. All patients were divided into two groups (the P group with PLC injuries and the C group without PLC injuries) for comparative examination.
RESULTS
Fourth-one of 100 cases showed PLC injuries in MRI study. The load sharing classification score was significantly higher in the P group [7.8+/-0.2 points for the P group and 6.9+/-1.1 points for the C group (p<0.001)]. The TLICS (excluded PLC score) score was also significantly higher in the P group [6.2+/-1.1 points for the P group and 4.0+/-1.4 points for the C group (p<0.001)].
CONCLUSION
The presence of PLC injury significantly influenced the severity of damage. In management of thoracic lumbar burst fractures, evaluation of PLC injury is important to accurately assess the severity of damage.

Keyword

Burst fracture; thoracic and lumbar spine; posterior ligamentous complex injury

MeSH Terms

Adolescent
Adult
Aged
Female
Humans
Ligaments, Articular/*injuries
Lumbar Vertebrae/*injuries
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Spinal Fractures/*classification/*physiopathology/surgery
Thoracic Vertebrae/*injuries
Young Adult

Figure

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  Fig. 1 The load-sharing classification. (A) Comminution/involvement. (B) Apposition of fragments. (C) Deformity correction.

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  Fig. 2 MRI T2WI: sagittal view (A) and axial view (B). This patient was ASIA C at the hospital admission and had a L1 burst injury (AO Type C fracture) with TLICS score of 9 points (3 points of rotation injury, 3 points of neurologic deficit, and 3 points of posterior ligament complex injury). TLICS, thoracolumbar injury classification system; T2WI, T2-weighted image; ASIA, American Spine Injury Association.

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  Fig. 3 Level and cases of thoracic and lumbar burst fractures.

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  Fig. 4 Distribution of ASIA impairment scale (AIS) in the two groups (the P group with PLC injury and the C group without PLC injury). PLC, posterior ligamentous complex.

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  Fig. 5 The detail of Denis classification and Magerl/AO classification in two groups (the P group with PLC injury and the C group without PLC injury). (A) Denis classification. (B) AO classification. PLC, posterior ligamentous complex.

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