Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures

Study design. Prospective study of patients with thoracolumbar spinal fract ures, Objectives. To assess the reliability of magnetic resonance imaging (MRI) f or posterior ligament complex injury in thoracolumbar spinal fractures. Summary of Background Data. Some researchers have studied posterior ligamen t complex injury in spinal fracture using MRI. However, most did not evalua te the findings of MRI compared with operative findings. Methods. Thirty-four patients with thoracolumbar spinal fracture were evalu ated by palpation of the interspinous gap, plain radiography, and MRI befor e operation. In addition to conventional MRI sequences, a fat-suppressed T2 -weighted sagittal sequence was performed. Surgery was performed by a poste rior approach. During the operation, posterior ligament complex injury was carefully examined. Results. A wide interspinous gap was palpated in 14 and was found in 21 pat ients on plain radiography. Magnetic resonance imaging raised suspicion of injury to the posterior ligament complex in 30 patients. According to inter pretation of MRI, injury to the supraspinous ligament was suspected in 27 p atients, the interspinous ligament in 30 patients, and the ligamentum flavu m in 9 patients. There were 28 supraspinous ligament injuries, 29 interspin ous ligament injuries, and 7 ligamentum flavum injuries in operative findin gs. There was a significant relation between MRI interpretation and operati ve findings. Conclusion. A fat-suppressed T2-weighted sagittal sequence of MRI was a hig hly sensitive, specific, and accurate method of evaluating posterior ligame nt complex injury. Based on the results of this study, a fat-suppressed T2- weighted sagittal sequence of MRIs is recommended for the accurate evaluati on of posterior ligament complex injury and would be helpful in the selecti on of treatment options.