Correlation Analysis Of Posterior Ligamentous Complex And Neurological Injury With Bony Imaging Parameters Of Thoracolumbar Injury

Background Thoracic lumbar injury as a result of its special physiologicalstructure and characteristics, so the rate was highest in cases of spinal cord injury.Clinically the most commonly used of the thoracolumbar injury classification system isDenis and classification system, American spinal injury TLICS standard put forward bythe research team has a widely attention in recent years. It evaluates the thoracolumbarinjury classification and the damage degree from the morphology of the fracture, PLCstate, neurologically functional status, which will conbine the simple fracturemorphology, ligament complex status and nerve damage. With thoracic lumbartreatment to the assessment of research, many scholars devoted quantitative evaluationto perfect chest lumbar injury through a standard treatment options. Whether choose thesurgical treatment for thoracolumbar damage mainly determined on the basis of thestability of the spine, and the stability of the spine and depends on osseous effect relatedto learning parameters of soft tissue and nerve damage, in which posterior ligamentouscomplex(PLC) injury plays an important role. PLC typical clinical manifestations ofspine after injury of spacing increases the width, and articular process of dislocation andsubluxation, and its diagnosis mainly by clinical examination of X-ray CTreconstruction of MRI, and other comprehensive evaluation. MRI scans is consideredjudgment after injury of thoracic lumbar segment PLC of the state of the gold standard.However, osseous structure imaging parameters threshold reaction PLC can, can makeMRI for evaluating PLC instead of the method of damage, which has not yet beenconfirmed at present.Objective To analyze the correlation of posterior ligamentous complex andneurological injury with bony imaging parameters(vertebral compression, translation,spinal canal invasion, and kyphosis, etc) in thoracolumbar injury.Methods Retrospective analysis of consecutive126patients with thoracolumbar injury (T11-L2) between January-December in2012was performed. The osteoporoticcompression fractures and pathologic fracture patients were excluded. All patientsshould have the tests of X-ray, CT scan and sagittal reconstruction, MRI scan. Localkyphosis, injured vertebral wedge angle, anterior and posterior injured vertebral heights,interspinous distance, vertebral translation, anteroposterior diameters of spinal canalwere measured on midsagittal CT scan. The injured vertebral compression ratio wascalculated. The distance of posterior wall fracture block broke into spinal canal weremeasured on axial CT scan and ratio of spinal canal invasion was calculated by dividingthe spinal canal anteroposterior diameter. The status of the PLC based on MRI signalswere recorded as intact, incomplete injury, or disrupted. Their ASIA motor scores andASIA Impaired Scale. Spearman correlation coefficients were analyzed to assess thecorrelation between bony imaging parameters, PLC injury, and neurological injury.Results There were6patients with local kyphosis>30°,8patients with injuredvertebral wedge angle>30°,12patients with local kyphosis>20°,22patients withwith injured vertebral wedge angle>20°,20patients with vertebral compressionrate>50%,58patients vertebral translation>3.5mm,12patients with interspinousdistance increases>7mm,24patients with spinal canal invasion ratio>50%. Accordingto MRI evaluation,34patients had PLC injury. There were significant positivecorrelation between local kyphosis>30°, vertebral translation>3.5mm, interspinousdistance increases>7mm and PLC injury. Significant negative correlations were foundbetween vertetral translation>3.5mm, vertetral translation>2.5mm, spinal canalinvasion ratio>50%, and neurological injury (AISA impaired Scale and ASIA motorscore). There were no significant correlations between PLC injury or neurological injuryand other bony imaging parameters.Conclusions Some thresholds for bony imaging parameters were not predictiveof PLC and neurological injury. When vertebral translation>3.5mm, local kyphosis>30°, interspinous distantce increases>7mm, thoracolumbar injury usually combinedwith PLC injury. Spinal canal invasion ratio>50%and vertebral translation>2.5mmtend to merge neurological injury. PLC and neurological structure status should beevaluated by MRI.