European Spine Journal

, Volume 26, Issue 5, pp 1447–1453 | Cite as

Another diagnostic tool in thoracolumbar posterior ligament complex injury: interspinous distance ratio

  • Ki Youn Kwon
  • Heui-Jeon Park
  • Ji Soo Shin
  • Jun Pyo Lee
Original Article



The increased interspinous distance ratio (ISDR) at the fracture site in plain X-ray is useful as an indicator of injury of the posterior ligament complex in thoracolumbar fractures.


154 patients of thoracolumbar junctional fracture (T12, L1, L2) were subjects for this study. The sensitivity, specificity, accuracy of MRI was measured by comparing the surgery findings for the two analysis groups: one in which indeterminate cases were included in the intact group and another in which the indeterminate cases were included in the ruptured group. Sensitivity, specificity, accuracy of ISDR (measured in lateral decubitus X-ray) were measured after dividing patients into 3 groups (110, 120, 130 % increased).


MRI’s sensitivity, specificity and accuracy were 70.8, 100, and 80.5 %, respectively, when the indeterminate was assumed to have intact PLC. After assuming the indeterminate to have ruptured PLC, sensitivity, specificity and accuracy were 99.1, 52.4, and 85.7 %, respectively. In 53 cases with indeterminate MRI reading, sensitivity, specificity and accuracy were 81.2, 76.2, and 79.2 % %, respectively.


In this study, in cases where it was difficult to make a diagnosis of the injury in the posterior ligament complex, based on the interspinous distance ratio (ISDR) of 120 % measured in plain X-ray in a lateral decubitus position, the sensitivity was 81.3 %, the specificity was 76.2 %, and the accuracy was 79.2 %. Therefore, measuring the ISDR will be helpful in determining whether surgical treatment is required in patients with thoracolumbar injury.


Interspinous distance Thoracolumbar junction fracture Posterior ligament complex 


Compliance with ethical standards

Conflict of interest



  1. 1.
    Barcelos AC, Joaquim AF, Botelho RV (2016) Reliability of the evaluation of posterior ligamentous complex injury in thoracolumbar spine trauma with the use of computed tomography scan. Eur Spine J (Germany) 25:1135–1143CrossRefGoogle Scholar
  2. 2.
    Crosby CG, Even JL, Song Y, Block JJ, Devin CJ (2011) Diagnostic abilities of magnetic resonance imaging in traumatic injury to the posterior ligamentous complex: the effect of years in training. Spine J 11:747–753CrossRefPubMedGoogle Scholar
  3. 3.
    Daffner RH, Deeb ZL, Rothfus WE (1987) The posterior vertebral body line: importance in the detection of burst fractures. AJR Am J Roentgenol 148:93–96CrossRefPubMedGoogle Scholar
  4. 4.
    Emery SE, Pathria MN, Wilber RG, Masaryk T, Bohlman HH (1989) Magnetic resonance imaging of posttraumatic spinal ligament injury. J Spinal Disord 2:229–233CrossRefPubMedGoogle Scholar
  5. 5.
    Haba H, Taneichi H, Kotani Y et al (2003) Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures. J Neurosurg 99:20–26PubMedGoogle Scholar
  6. 6.
    Hiyama A, Watanabe M, Katoh H, Sato M, Nagai T, Mochida J (2015) Relationships between posterior ligamentous complex injury and radiographic parameters in patients with thoracolumbar burst fractures. Injury (Netherlands) 46:392–398CrossRefGoogle Scholar
  7. 7.
    Hosmer DW, Hosmer T, Le Cessie S, Lemeshow S (1997) A comparison of goodness-offit tests for the logistic regression model. Stat Med 16:965–980CrossRefPubMedGoogle Scholar
  8. 8.
    Kepler CK, Vaccaro AR, Koerner JD, Dvorak MF, Kandziora F, Rajasekaran S, Aarabi B, Vialle LR, Fehlings MG, Schroeder GD, Reinhold M, Schnake KJ, Bellabarba C, Cumhur Öner F (2016) Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons. Eur Spine J 25:1082–1086CrossRefPubMedGoogle Scholar
  9. 9.
    Kliewer MA, Gray L, Paver J et al (1993) Acute spinal ligament disruption: MR imaging with anatomic correlation. J Magn Reson Imaging 3:855–861CrossRefPubMedGoogle Scholar
  10. 10.
    Krompinger WJ, Fredrickson BE, Mino DE, Yuan HA (1986) Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am 17:161–170PubMedGoogle Scholar
  11. 11.
    Lee HM, Kim DJ, Kim HS, Suk KS, Kim NH, Park SY (2000) Reliability of MRI to detect posterior ligament complex injury in thoracolumbar spinal fractures. J Korean Soc Spine Surg 7:70–76Google Scholar
  12. 12.
    Lee HM, Kim HS, Kim DJ, Suk KS, Park JO, Kim NH (2000) Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures. Spine (Phila Pa 1976) 25:2079–2084CrossRefGoogle Scholar
  13. 13.
    Lee JY, Vaccaro AR, Schweitzer KM Jr et al (2007) Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography. Spine J 7:422–427CrossRefPubMedGoogle Scholar
  14. 14.
    Oner FC, vd Rijt RH, Ramos LM, Groen GJ, Dhert WJ, Verbout AJ (1999) Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures. Eur Spine J 8:194–198CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Park HJ, Lee PE, Lee BH, Kim MS (2005) Relationships between posterior ligament complex injury and plain radiograph in thoracolumbar spinal fracture. J Korean Soc Spine Surg 12:140–145CrossRefGoogle Scholar
  16. 16.
    Pizones J, Castillo E (2013) Assessment of acute thoracolumbar fractures: challenges in multidetector computed tomography and added value of emergency MRI. Semin Musculoskelet Radiol (United States) 17:389–395CrossRefGoogle Scholar
  17. 17.
    Pizones J, Sánchez-Mariscal F, Zúñiga L, Alvarez P, Izquierdo E (2013) Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine. Spine (Phila Pa 1976) 38:745–751CrossRefGoogle Scholar
  18. 18.
    Shen WJ, Liu TJ, Shen YS (2001) Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976) 26:1038–1045CrossRefGoogle Scholar
  19. 19.
    Terk MR, Hume-Neal M, Fraipont M, Ahmadi J, Colletti PM (1997) Injury of the posterior ligament complex in patients with acute spinal trauma: evaluation by MR imaging. AJR Am J Roentgenol 168:1481–1486CrossRefPubMedGoogle Scholar
  20. 20.
    Vaccaro AR, Lee JY, Schweitzer KM Jr et al (2006) Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J 6:524–528CrossRefPubMedGoogle Scholar
  21. 21.
    Vaccaro AR, Rihn JA, Saravanja D et al (2009) Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine (Phila Pa 1976) 34:E841–847CrossRefGoogle Scholar
  22. 22.
    Vaccaro AR, Zeiller SC, Hulbert RJ et al (2005) The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech 18:209–215PubMedGoogle Scholar
  23. 23.
    van Middendorp JJ, Patel AA, Schuetz M, Joaquim AF (2013) The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature. Eur Spine J (Germany) 22:461–474CrossRefGoogle Scholar
  24. 24.
    Zhuge W, Ben-Galim P, Hipp JA, Reitman CA (2015) Efficacy of MRI for assessment of spinal trauma: correlation with intraoperative findings. J Spinal Disord Tech (United States) 28:147–151CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ki Youn Kwon
    • 1
  • Heui-Jeon Park
    • 1
  • Ji Soo Shin
    • 1
  • Jun Pyo Lee
    • 1
  1. 1.Department of Orthopedics, Wonju College of MedicineYonsei UniversityWonjuKorea

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