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*, Alpesh A. Patel, Michael Schuetz, Andrei F. Joaquim

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)461-474
Number of pages14
JournalEuropean Spine Journal
Volume22
Issue number3
DOIs
StatePublished - Mar 2013

Keywords

  • Lumbar spine
  • Posterior ligamentous complex
  • Spinal injuries
  • Systematic review
  • Thoracic spine
  • Thoracolumbar spine

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Fingerprint

Dive into the research topics of 'The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: A critical appraisal of the literature'. Together they form a unique fingerprint.

Cite this