Department of Neurosurgery, General Aoyama Hospital.
Department of Neurosurgery, Nagoya University Hospital.
Neurol Med Chir (Tokyo). 2023 Apr 15;63(4):158-164. doi: 10.2176/jns-nmc.2021-0390. Epub 2023 Mar 1.
The goal of this study is to perform correlation analysis of Computed tomography (CT) and magnetic resonance imaging (MRI) results in posterior ligament complex (PLC) injury and define the morphological traits of thoracolumbar (TL) burst fractures connected to PLC injury. Forty patients with surgically repaired TL burst fractures between January 2013 and December 2020 were retrospectively analyzed. The patients were split into two groups for comparison based on MRI (Group P: patients with a confirmed or suspected PLC injury; Group N: patients with PLC injury denied). The radiographic morphological examination based on CT scans and clinical evaluation was performed and compared between two groups. The thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores, and the number of patients with neurological impairments were considerably greater in Group P. Loss of height of the fracture (loss height), local kyphosis of the fracture (local kyphosis), and supraspinous distance were significantly higher in Group P and significantly associated with PLC injuries indicating severe vertebral body destruction and traumatic kyphosis in multivariate logistic analysis [odds ratio: 1.90, 1.06, and 1.13, respectively]. Cutoff value for local kyphosis obtained from the receiver operating characteristic curve was 18.8. If local kyphosis is greater than 18.8 degrees on CT scans, we should take into account the probability of the highly damaged burst fracture associated with PLC injury. In this situation, we should carefully assess MRI to identify the spinal cord injury or spinal cord compression in addition to PLC injury because these instances likely present with neurological abnormalities.
本研究旨在对后纵韧带复合体（PLC）损伤的 CT 和磁共振成像（MRI）结果进行相关分析，并定义与 PLC 损伤相关的胸腰椎（TL）爆裂骨折的形态特征。回顾性分析了 2013 年 1 月至 2020 年 12 月期间接受手术治疗的 40 例 TL 爆裂骨折患者。根据 MRI 将患者分为两组进行比较（组 P：证实或疑似 PLC 损伤的患者；组 N：否认 PLC 损伤的患者）。对两组患者进行 CT 扫描的影像学形态检查和临床评估，并进行比较。组 P 的胸腰椎损伤分类和严重程度评分（TLICS）、负荷分担分级（LSC）评分和存在神经功能损伤的患者数量明显更多。组 P 的骨折高度丢失（丢失高度）、骨折局部后凸（局部后凸）和棘突间距离明显更高，且与 PLC 损伤显著相关，多变量逻辑分析表明严重的椎体破坏和创伤性后凸（比值比：1.90、1.06 和 1.13）。受试者工作特征曲线获得的局部后凸的截断值为 18.8。如果 CT 扫描上的局部后凸大于 18.8 度，我们应该考虑 PLC 损伤相关的严重爆裂骨折的可能性。在这种情况下，我们应该仔细评估 MRI，以确定脊髓损伤或脊髓压迫，除了 PLC 损伤，因为这些情况可能存在神经功能异常。
