Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013 Mar;22(3):461-74.
doi: 10.1007/s00586-012-2602-7. Epub 2012 Dec 1.

The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature

Joost J van Middendorp  1 , Alpesh A Patel, Michael Schuetz, Andrei F Joaquim
Affiliations
Review

The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature

Joost J van Middendorp et al. Eur Spine J. 2013 Mar.

Abstract

Purpose: The diagnostic assessment and prognostic value of the posterior ligamentous complex (PLC) remains a controversial topic in the management of patients with thoracolumbar spinal injury. The purpose of this review was to critically appraise the literature and present an overview of the: (1) precision, (2) accuracy, and (3) validity of detecting PLC injuries in patients with thoracic and lumbar spine trauma.

Methods: Studies evaluating the precision, accuracy and/or validity of detecting and managing PLC injuries in patients with thoracic and/or lumbar spine injuries were searched through the Medline database (1966 to September 2011). References were retrieved and evaluated individually and independently by two authors.

Results: Twenty-one eligible studies were identified. Few studies reported the use of countermeasures for sampling and measurement bias. In nine agreement studies, the PLC was assessed in various ways, ranging from use of booklets to a complete set of diagnostic imaging. Inter-rater and intra-rater kappa values ranged from 0.188 to 0.915 and 0.455 to 0.840, respectively. In nine accuracy studies, magnetic resonance (MR) imaging was most often (n = 6) compared with intra-operative findings. In general, MR imaging tended to demonstrate relatively high negative predictive values and relatively low positive predictive values for PLC injuries.

Conclusions: A wide variety of methods have been applied in the evaluation of precision and accuracy of PLC injury detection, leaving spinal surgeons with a multitude of variable results. There is scant clinical evidence demonstrating the true prognostic value of detected PLC injuries in patients with thoracic and lumbar spine injuries. We recommend the conduct of longitudinal clinical follow-up studies on those cases assessed for precision and/or accuracy of PLC injuries.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Syntax used to identify potentially relevant references in Medline using the PubMed interface (1966 to September 2011)
Fig. 2
Fig. 2
A schematic representation of assessing agreement, accuracy and clinical relevance of PLC injury detection in patients with thoracic and lumbar spine trauma, using two different diagnostic modalities (CT alone vs. CT and MRI)
See this image and copyright information in PMC

References

    1. Mirza SK, Mirza AJ, Chapman JR, Anderson PA. Classifications of thoracic and lumbar fractures: rationale and supporting data. J Am Acad Orthop Surg. 2002;10(5):364–377. - PubMed
    1. van Middendorp JJ, Audige L, Hanson B, Chapman JR, Hosman AJ. What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications. Eur Spine J. 2010;19(8):1238–1249. doi: 10.1007/s00586-010-1415-9. - DOI - PMC - PubMed
    1. Holdsworth FW. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Jt Surg Br. 1963;45-B(1):6–20. - PubMed
    1. Vaccaro AR, Lehman RA, Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005;30(20):2325–2333. doi: 10.1097/01.brs.0000182986.43345.cb. - DOI - PubMed
    1. Vaccaro AR, Zeiller SC, Hulbert RJ, Anderson PA, Harris M, Hedlund R, et al. The Thoracolumbar Injury Severity Score: a proposed treatment algorithm. J Spinal Disord Tech. 2005;18(3):209–215. - PubMed

MeSH terms