Posterior Ligamentous Complex Injury in Thoracolumbar Burst Fractures: Correlating CT and MRI Findings

Introduction: Posterior ligamentous complex (PLC) injuries in thoracolumbar burst fractures are critical indicators of spinal stability and potential neurological impairment. Accurate identification through imaging is essential to guide treatment decisions. This study aims to correlate computed tomography (CT) and magnetic resonance imaging (MRI) findings to improve PLC injury diagnosis and inform surgical planning.

Methods: This retrospective study reviewed imaging data from 40 patients with thoracolumbar burst fractures between 2013 and 2023. Patients were categorized based on PLC injury status confirmed through MRI. CT scans were analyzed for morphological markers such as kyphosis angle, fracture height loss, and supraspinous ligament disruption. Statistical analyses, including logistic regression and receiver operating characteristic (ROC) curve analysis, were performed using Python and R to identify CT markers predictive of MRI-confirmed PLC injury.

Results: MRI confirmed PLC injury in 60% of cases, with a high correlation to specific CT findings. Significant predictors included increased local kyphosis (mean >18°), fracture height loss, and widened supraspinous distance (p < 0.05). ROC analysis indicated that a kyphosis angle cutoff of 18.8° on CT provided high sensitivity and specificity for PLC injury prediction. Patients with confirmed PLC injury demonstrated higher Thoracolumbar Injury Classification and Severity (TLICS) scores, suggesting greater spinal instability and need for surgical intervention.

Conclusion : CT morphological markers, particularly kyphosis angle and fracture height loss, strongly correlate with MRI-confirmed PLC injury in thoracolumbar burst fractures. These findings support the use of CT as an initial screening tool, potentially reducing reliance on MRI in emergency settings. Incorporating CT indicators into routine assessments may enhance early detection of PLC injuries, facilitating prompt and appropriate management. Further studies with larger sample sizes are recommended to validate these correlations and refine predictive thresholds.