Table 2.
Studies on the Accuracy or Reliability of Computed Tomography in Diagnosis of Posterior Ligamentous Complex Injury.
| Author | Data collection | Number of reviewers | Number of Patients | Objectives | Imaging Evaluated | Definition of PLC Injury | Key Findings |
|---|---|---|---|---|---|---|---|
| Aly et al (2022) | Retrospective | 3 | 41 | To determine the impact of MRI on fracture classification for low lumbar fractures compared to CT alone. | 64-slice multidetector CT scanner and 1.5-Tesla or 3-Tesla MRI | PLC injury in MRI was defined by black stripe discontinuity and in CT by ≥ 1 of the following presence of: vertebral body translation, facet joint malalignment, horizontal laminar or spinous process fracture, and interspinous widening | CT was highly accurate (95%) for diagnosis of PLC injury in lower lumbar fractures. Addition of MRI after CT did not change the AO classification or TLISS, compared to CT alone |
| Aly et al (2021) | Retrospective | 2 | 271 | To determine diagnostic value of morphological features of horizontal laminar fracture and vertical laminar fracture for diagnosis of PLC injury. | 64-slice multidetector CT scanner and 1.5-Tesla or 3-Tesla MRI | Black stripe discontinuity due to SSL or LF rupture | Bilateral HLFs, laminar and pedicle fractures, and displaced HLFs, but not any VLF subtypes, were independently associated with PLC injury, aiding CT-diagnosis of PLC injury |
| Durmaz et al (2021) | Prospective | 3 | 180 | To investigate the role of MRI in decision making for thoracic and lumbar fractures | 3-Tesla MRI scanner | Black stripe discontinuity | There was a weak correlation between Xray + CT and post-MRI classification for AO type B fractures, and MRI classified AO type B fractures significantly more accurately than Xray + CT MRI findings were significantly correlated to PLC disruption during intraoperative ligament assessment MRI changed treatment plan in favor of surgery in 33.9% of patients where CT/X-ray suggested non-operative treatment |
| Aly et al (2021) | Retrospective | 2 | 263 | To determine the diagnostic accuracy of combined CT findings for detecting PLC injury in MRI | CT images were obtained using a 64-slice multidetector CT | Black stripe discontinuity on MRI due to SSL or LF rupture | Facet joint malalignment, spinous process fracture, horizontal laminar fracture, and interspinous widening were independently associated with PLC injury Two or more CT findings yielded a positive predictive value of 91% for PLC injury, while a single finding is associated with 34% PPV for PLC injury |
| Ganjeifar et al (2019) | Retrospective | 98 | To evaluate the diagnostic value of CT scan in predicting PLC injuries | MRI and CT type not specified | Not specified | A significant relationship exists between facet joint widening, increased interspinous process distance, and spinous process avulsion fracture with PLC disruption. Diagnostic results of CT were similar to MRI |
|
| Khurana et al (2018) | Retrospective | 3 | 105 | To determine whether secondary CT findings can predict PLC injury | 128-slice CT scanner and 1.5-Tesla or 3.0-Tesla MRI | Any high signal intensity with or without black stripe discontinuity | At least one positive CT finding was found to yield average sensitivity of 82%, while two or more positive findings yielded average specificity of 88%. Interobserver reliability was poorest for interspinous widening. OR of PLC injury was 3.8 to 5.6 with one CT findings vs no positive CT findings, and 13.6 to 25.1 with two or more positive CT findings |
| Jiang et al (2018) | Retrospective | 2 | 88 | To examine the accuracy of some radiographic parameters and interspinous widening in CT to detect PLC injury in MRI | CT with single-detector helical protocol with a 3-mm-overlapping axial slice thickness and image reformatting in the sagittal and coronal planes | Any high signal intensity with or without black stripe discontinuity | On CT, PLC injury was associated interspinous distance ratio, and interspinous distance minus. |
| Rajasekaran et al (2016) | Retrospective | 2 | 60 | To examine the accuracy of interspinous widening in CT to detect PLC injury in MRI | 1.5 Tesla MRI | hyperintense signal changes in the PLC complex | An increase in interspinous distance by 2mm, on its own, was associated with a sensitivity of 60 % and specificity of 57 %. When considering presence of both factors of LK greater than 25° and interspinous distance greater than 2.5 mm the specificity was 97 %. |
| Barcelos et al (2016) | Retrospective | 3 | 43 | To evaluate the reliability of CT findings in the diagnosis of PLC injury | CT with single-detector helical protocol with a 3-mm- axial slice thickness and image reformatting in the sagittal and coronal planes. | facet joint diastasis, sagittal translation, increased interspinous distance, horizontal translation, and rotation of the vertebra | The intraobserver reliability for the PLC injury parameters ranged from .518 to 1.000, except for increased interspinous distance. Interobserver reliability ranged from .303 to .688 |
| Winklhofer et al (2013) | Retrospective | 3 | 100 | To evaluate the influence of additional MRI compared with CT alone for the classification of thoracolumbar traumatic fractures | CT with .6 mm slice thickness and 1.5-Tesla MRI | On CT, PLC injury was defined when one or more of the following: facet joints diastasis, avulsion fracture of the superior or inferior aspect of contiguous spinous processes, vertebral translation, or an interspinous spacing greater than that of the level above or below On MRI, Any high signal intensity with or without black stripe discontinuity |
With CT alone the integrity of the PLC was defined as intact in 80%, suspect in 2%, and injured in 18% of the 100 patients. With CT and MRI together the PLC was assessed as intact in 55 out of 55%, suspect in 3%, and injured in 42% patients. |
| Pizones e tal (2012) | Prospective | 2 | 33 | Impact of MRI on decision making For thoracolumbar traumatic fracture diagnosis and treatment |
CT not specificized, 1.5-Tesla MRI | Black stripe discontinuity | MRI offers additional information compared to other diagnostic tools: it modified our diagnosis in 40% of our patients, classification fracture pattern in 24% of our fractures and therapeutic management in 16% of our patients. |
| Lefrink et al (2002) | Retrospective | NR | 160 | To determine the diagnostic accuracy of CT findings for detecting PLC injury compared to intraoperative findings | Not specificized | Intraoperative verification of ligamentous injury | Thirty percent of Type B fractures are misdiagnosed when plain X-rays and CT scans with 2D reconstructions are used as the only preoperative diagnostic tools |
| Peterslige et al (1994) | Retrospective | 2 | 21 | frequency of diagnosis of PLC injury In MRI compared to CT alone | 1.0 and 1.5 T MRI | Any high signal intensity with or without discontinuity of SSL | CT predictors of ligamentous injury were present in only 33% of cases with SSL rupture in MRI |
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.