Reliability of MRI to Detect Posterior Ligament Complex Injury in Thoracolumbar Spinal Fractures

Lee, Hwan Mo; Kim, Dong Jun; Kim, Hak Sun; Suk, Kyung Soo; Kim, Nam Hyun; Park, Si Young

Abstract

STUDY DESIGN: Prospective study of 34 patients with thoracolumbar spinal fractures.
OBJECTIVES
To assess the reliability of MRI in detecting posterior ligament complex(PLC) injury in thoracolumbar spinal fractures. SUMMARY OF LITERATURE REVIEW: Some researchers have studied PLC injury in spinal fracture using MRI. However, most of them did not evaluate the findings of MRI compared to the operative findings.
MATERIALS AND METHODS
Thirty-four patients with thoracolumbar spinal fracture were evaluated by palpating the interspinous gap, plain radiography and MRI before operation. These findings were compared with operative findings. In addition to conventional MRI sequences, a fat-suppressed T2-weighted sagittal sequence was performed. Operation was performed by posterior approach. During the operation, we carefully examined the PLC injury.
RESULTS
Wide interspinous gap was palpated in 14 patients and was found in 21 patients on plain radiography. PLC injury was suspected in 30 patients on MRI. Injury to supraspinous ligament(SSL) was suspected in 27 patients; interspinous ligament(ISL) in 30 patients; and ligamentum flavum(LF) in 9 patients on MRI. There were 28 SSL injuries, 29 ISL injuries, and 7 LF injuries on operative findings. There was a significant relation between the MRI and operative findings.
CONCLUSIONS
A fat-suppressed T2-weighted sagittal sequence of MRI was a highly sensitive, specific, and accurate method of evaluating PLC injury. Based on the results of this study, a fat-suppressed T2-weighted sagittal sequence of MRI is recommended for the accurate evaluation of PLC injury and would be helpful in the selection of treatment options.