Introduction: Current paradigms for the treatment of spinal fractures rely on clinical, radiographic and MRI criteria to decide on management. The posterior ligamentous complex (PLC) though evasive, and difficult to quantitate is integral to these paradigms. This review is intended to evaluate the frequency of PLC disruption in thoracic and lumbar burst fractures in patents with deficit or intact.
Methods: A retrospective review of thoracic and lumbar burst fractures with retrievable MRI studies was performed. A total of 101 patients were available. Based on the MRI studies, the status of the posterior ligamentous complex (PLC) was assessed for integrity or disruption.
Results: There were 67 intact patients, and 34 with deficit. Patients who were intact (30 M, 37 F) had a mean age of 45+/- 18 years. The residual canal , and kyphotic angle measured 58+/- 15%, and 3+/-9%. Of the 67 intact patients, 9 had disrupted PLC. Based on standard neurosurgical criteria, 16 of the intact patients required surgery. Of the patients with deficit (22 M, 12 F), the residual canal and kyphotic angle measured 49+/- 19%, and 2.5+/-11% respectively. The PLC was disrupted in 11 of 34 (p=0.034 compared to the intact). All of the patients with deficit underwent surgery for decompression and stabilization.
Conclusions: The PLC disruption was significantly more prevalent in burst fractures with deficit (p=0.034). In the intact patients, PLC disruption was more prevalent in the cohort undergoing surgery (p=0.001). The PLC was disrupted in intact patients who were successfully treated non-operatively. Notwithstanding the importance of the PLC, treatment of burst fractures should take into account clinical, CT, as well as MRI criteria.
Patient Care: Disruption of the spinal ligaments can lead to long term problems of kyphotic angulation of the spine that can lead to pain and long term disability. With a better understanding of the severity of ligamentous injury following a spine fracture based on clinical presentation as well as imaging studies we can better assess and evaluate the need for early decompression and fusion.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Better understand the role the posterior ligamentous complex has in patients with burst fractures with or without neurological deficit, 2) Describe the importance of the patient's clinical picture along with a multi-image modality approach to treating patients with burst fractures and posterior ligamentous complex integrity, 3) Identify an effective treatment strategy for patients with burst fractures and posterior ligamentous complex disruption.