X-ray and CT scan predictors of damage to the posterior ligamentous complex in fractures of the vertebral bodies of the thoracolumbar junction: systematic review and meta-analysis

Abstract

Objective of the review was to identify, basing on literature data, the most reliable X-ray and CT signs of damage to the posterior ligamentous complex (PLC) in fractures of the vertebral bodies of the thoracolumbar junction, initially interpreted as type A according to the AOSpine classification. The systematic review was carried out according to the recommendations of PRISMA. The search in PubMed, MEDLINE and Cochrane Library databases revealed 491 articles on relevant issues. Once the inclusion and exclusion criteria have been met, 7 original articles from peer-reviewed scientific journals for the last 10 years were selected for a systematic review, 6 of which were included in the meta-analysis. In all articles, the authors identified two groups of patients: with and without damage to the PLC. The PLC damages were confirmed by MRI and intraoperatively. Radiographic and CT spondylometric parameters were identified, which had statistically significant differences between the groups. To determine predictors of PLC damage, the values of these parameters were subjected to regression analysis. This was followed by a meta-analysis of random and fixed effects models depending on the homogeneity of the data. Statistical heterogeneity was assessed using the X-square test with the null hypothesis of the absence of significant differences in all studies, as well as the heterogeneity index – I2. For the graphical display of the results, forest plots were built. Local kyphosis angle >25°, Cobb angle >16° and difference between interspinous distances >2.54 mm are CT scan predictors of PLC damage. The parameters characterizing the interspinous relationship were studied in no more than two studies, but at the same time they always had statistically significant differences between the groups with and without PLC injuries, therefore, they cannot be ignored during diagnosis. Anterior/posterior vertebral height ratio, anterior vertebral height ratio, sagittal index and suprajacent/subjacent parameters are not the predictors of PLC damage.