Table 1.

Studies on the Accuracy or Reliability of Magnetic Resonance Imaging in Diagnosis of Posterior Ligamentous Complex injury.

Author	Objectives	Levels	Data collection	Number of Patients	Number of reviewers	MRI field strength	Definition of PLC Injury	Key Findings
Aly et al (2022)	Frequency of change of fracture classification by MRI compared to CT alone	T1-L5	Retrospective	244	4	1.5 T and 3 T MRI	Black stripe discontinuity due to SSL or LF rupture	MRI changes the fracture classification in 10 % of cases. Perfect agreement on MRI evaluation of PLC(k = .89).
Mehta et al (2021)	To evaluate the diagnostic accuracy of MRI in PLC injury compared to intraoperative findings	T1-L3	Prospective	58	2	Not specified	Black stripe discontinuity due to SSL or LF rupture	MRI sensitivity for intact PLC components ranged from 100% SSL to 66.67% LF. MRI specificity ranged from 100% ISL to 52% thoracolumbar fascia.
Lee et al (2015)	To evaluate spine MRI inter-reader and intra-reader reliabilities for the TLICS score	Thoracolumbar	Retrospective	100	1	1.5 T and 3 T MRI	Not specified	Inter-reader agreement of MRI was fair to moderate (k = .440 for the first and .389 for the second review) for PLC integrity. Intra-reader agreement was .423-.616. Experience did not influence difference in inter-reader agreement
Pizones et al(2013)	To study MRI accuracy for detecting PLC injury	T1-L5	Prospective	58	3	Not specified	Black stripe discontinuity due to SSL or LF rupture	MRI sensitivity for injury diagnosis of each isolated PLC component varied between 92.3% ISL and 100% LF 100% SSL. PLC integrity sensitivity and specificity as a whole were 91% and 100%.
Vaccaro et al (2009)	To study MRI accuracy for detecting PLC injury compared to intraoperative findings	T1-L3	Prospective	42	1	Not specified	Any high signal intensity with or without black stripe discontinuity	MRI sensitivity for the various components of the PLC ranged from 79% left FC to 90% ISL. The specificity ranged from 53% thoracolumbar fascia to 65% LF, the PPV ranged from 70.4% left FC to 78.4% ISL, and the NPV ranged from 50.0% thoracolumbar fascia to 88.2% right FC.
Dai et al (2009)	To measure the reliability of MRI in detecting PLC injury.	T11-L1	Retrospective	61	3	1.5-Tesla MRI	Any high signal intensity with or without black stripe discontinuity	The kappa coefficients for ISL or SSL injury ranged .601 to .736, representing substantial to almost perfect agreement.
Schweitzner et al (2007)	To determine the interrater reliability of indicators of PLC integrity on MRI and CT	T3-L3	Retrospective	13	13	16-slice CT 1.5-Tesla MRI	1) facet joint diastasis on CT; (2) high signal intensity in the region of PLC components on sagittal T2W FAT SAT MRI; and (3) discontinuity of black strip on sagittal T1W MRI	Absolute interrater percent agreement on facet diastasis and posterior edema-like signal in the region of PLC components on sagittal T2-weighted MRI was similar (agreement 70.5%).Facet joint diastasis on CT was the most reliable indicator of PLC disruption (κ = .395).
Haba et al (2003)	To assess the diagnostic accuracy of MRI in detection of PLC injury compared to intraoperative findings	T2-L5	Retrospective	35	3	.5-1.5-tesla MRI	Any high signal intensity with or without black stripe discontinuity	The diagnostic accuracy of MR imaging in detecting injury of the SSL and ISL was 90.5 and 94.3%, respectively. T1W MRI alone was more specific injury than T2W MRI alone. The overall mean κ coefficient for MR imaging findings of PLC injury was .803,and was greater for ISL (κ = .915) compromise than SSL (κ = .69) compromise.
Lee et al (2000)	To assess the reliability of MRI for PLC injury in thoracolumbar spinal fractures.	Thoracolumbar	Prospective	34	1	Not specified	A wide interspinous gap compared with the adjacent interspinous spaces on palpation or plain radiography (more than a 20% increase	SSL injury was suspected on MRI in 27 patients, ISL in 30 patients, and LF in 9 patients. There were 28 SSL injuries, 29 ISL injuries, and 7 LF injuries in operative findings. There was a significant relation between MRI interpretation and operative findings.
Emery et al (1989)	To review the accuracy MRI findings of patients with PLC injury compared to CT alone	Thoracolumbar	Retrospective	37	NR	1.0 T or 1.5 Tesla MRI	Any high signal intensity with or without black stripe discontinuity	MRI detected ligament damage in 17/19 (89%) cases of PLC injury. However, the only misdiagnosed thoracolumbar PLC injury was the only MRI performed without T2 sequences and performed at an outside hospital

Abbreviations: MRI, magnetic resonance imaging; SSL, supraspinous ligament; PLC, posterior ligamentous complex; CT, computed tomography; LF, ligamentum flavum; FC, facet joint capsules; ISL, interspinous ligament.