Posterior Ligamentous Complex Injury as a Determinant of Surgical Management in Burst Fractures

Introduction: Posterior ligamentous complex (PLC) consists of multiple ligaments within the spine aiding in its stability. Injury to the PLC is understood to be a detriment to the stability of the spine and healing of associated fracture, thus requiring operative management. However, there is minimal data on PLC injuries, its associated fractures, and the type of management. This study aims to provide information of PLC injuries in the setting of burst fractures.

Methods: We conducted a retrospective cohort study using a statewide institutional database comprising 177 patients from 2018 to 2023 who presented to a Level 1 Trauma Center with vertebral fracture injuries. We categorized them into two groups: No PLC injury (reference group) and PLC injury. Demographic and clinical characteristics were compared using Chi-square and Fisher’s exact tests, and multivariable logistic regression analyses were conducted to identify the model with the optimal performance metrics determining surgical versus medical management. The primary outcome was the need for surgical intervention. Logistic Regression analysis was performed to assess the association between PLC injury and surgical intervention, adjusting for potential confounders.

Results: PLC injury was significantly associated with increased odds of surgical intervention OR 4.53 (95% CI: 1.28-16.0, p = 0.019). We found 47.5% of surgical patients presented with a neurological deficit compared to 28.0% of medical management patients (p = 0.016).

Conclusion : PLC injury significantly increases the likelihood of surgical intervention in burst fractures. This finding provides supporting evidence that PLC injury plays a critical role in surgical decision making in the setting of burst fractures.