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Aly MM, Al-Shoaibi AM, Aljuzair AH, Issa TZ, Vaccaro AR. A Proposal for a Standardized Imaging Algorithm to Improve the Accuracy and Reliability for the Diagnosis of Thoracolumbar Posterior Ligamentous Complex Injury in Computed Tomography and Magnetic Resonance Imaging. Global Spine J 2023; 13:873-896. [PMID: 36222735 DOI: 10.1177/21925682221129220] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Literature Review. OBJECTIVE To propose a systematic imaging algorithm for diagnosing posterior ligamentous complex (PLC) injury in computed tomography (CT) and magnetic resonance imaging (MRI) to improve the reliability of PLC assessment. METHODS A systematic review was conducted following PRISMA guidelines. The Scopus database was searched from its inception until July 21, 2022, for studies evaluating CT or MRI assessment of the PLC injury following thoracolumbar trauma. The studies extracted key findings, objectives, injury definitions, and radiographic modalities. RESULTS Twenty-three studies were included in this systematic review, encompassing 2021 patients. Five studies evaluated the accuracy of MRI in detecting thoracolumbar PLC injury using intraoperative findings as a reference. These studies indicate that black stripe discontinuity due to supraspinous or ligamentum flavum rupture is a more specific criterion of PLC injury than high-signal intensity. Thirteen papers evaluated the accuracy or reliability of CT in detecting thoracolumbar PLC injury using MRI or intraoperative findings as a reference. The overall accuracy rate of CT in detecting PLC injury was 68-90%. Two studies evaluate the accuracy of combined CT findings, showing that ≥2 CT findings are associated with a positive predictive value of 88-91 %. Vertebral translation, facet joint malalignment, spinous process fracture, horizontal laminar fracture, and interspinous widening were independent predictors of PLC injury. CONCLUSION We provided a comprehensive imaging algorithm for diagnosing PLC in CT and MRI based on available literature and our experience. The algorithm will potentially improve the accuracy and reliability of PLC assessment, however it needs multicentre prospective validation.
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Affiliation(s)
- Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Abdulbaset M Al-Shoaibi
- Department of Diagnostic Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Ali H Aljuzair
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Tariq Ziad Issa
- Orthopaedic Surgery, 387400Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Orthopaedic Surgery, 387400Rothman Orthopedic Institute, Philadelphia, PA, USA
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Aly MM, Al-Shoaibi AM, Abduraba Ali S, Almutairi HM, Kormi YH, Abdelaziz M, Eldawoody H. Which Morphological Features of Facet Diastasis Predict Thoracolumbar Posterior Ligamentous Complex Injury as Defined by Magnetic Resonance Imaging? World Neurosurg 2023; 171:e276-e285. [PMID: 36521759 DOI: 10.1016/j.wneu.2022.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association of various morphological features of facet diastasis with posterior ligamentous complex (PLC) injury has not been previously described. This study aims to determine the diagnostic value of facet diastasis subtypes for diagnosing thoracolumbar PLC injury. METHODS We retrospectively reviewed 337 consecutive patients with acute thoracolumbar fractures who had computed tomography (CT) and magnetic resonance imaging (MRI) within 10 days of injury. Three and 5 reviewers evaluated MRI and CT images, respectively. Facet diastasis was subclassified as follows: Dislocated, no articular surface apposition; subluxed, incomplete articular surface apposition; and facet fracture articular process fractures which may be displaced ≥2 mm or otherwise undisplaced, facet joint widening (FJW) ≥ 3 mm. We examined the diagnostic accuracy and the multivariate associations of facet diastasis subtypes with PLC injury in MRI. RESULTS Facet dislocation, subluxation, and displaced facet fracture yielded a high positive predictive value (PPV) for PLC injury (96%, 88%, and 94%, respectively). In contrast, undisplaced facet fracture and FJW yielded a moderate PPV for PLC injury (78%, and 45%, respectively). Facet dislocation, subluxation, and displaced facet fracture showed independent associations with PLC injury (adjusted odds ratio [AOR] = 38.4, 17.1, 13.4, respectively; P < 0.05). Undisplaced facet fracture and FJW were not associated with PLC injury (AOR = 3.9 [95% confidence interval, 0.49-38.4], P = 0.20) and (AOR = 1.94 [95% confidence interval, 0.48-7.13]; P = 0.20; P = 0.33), respectively. CONCLUSIONS Facet dislocation, subluxation, and displaced facet fracture, but not undisplaced facet fracture or FJW, were independently associated with PLC injury. Therefore, we propose to define facet diastasis as a surrogate marker of PLC injury in MRI based on these morphologies.
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Affiliation(s)
- Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia; Department of Neurosurgery, Mansoura University, Mansoura, Egypt.
| | - Abdulbaset M Al-Shoaibi
- Department of Diagnostic Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Saleh Abduraba Ali
- Department of Diagnostic Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Hatem Mashan Almutairi
- Department of Diagnostic Radiology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Yahya H Kormi
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Hany Eldawoody
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia; Department of Neurosurgery, Mansoura University, Mansoura, Egypt
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Anaya JEC, Coelho SRN, Taneja AK, Cardoso FN, Skaf AY, Aihara AY. Differential Diagnosis of Facet Joint Disorders. Radiographics 2021; 41:543-558. [PMID: 33481690 DOI: 10.1148/rg.2021200079] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Spinal pain due to facet joint disease is difficult to diagnose since the clinical history and physical examination findings are usually nonspecific. Facet joint disorders have a wide range of causes and, because of the potential for chronic back pain and disability, an accurate diagnosis is essential. The most frequent cause of pain in facet joints is osteoarthritis, which can be assessed at radiography, CT, or MRI. Ganglion and synovial cysts of the facet joints can cause compressive symptoms of adjacent structures, especially radiculopathy, lower back pain, and sensory or motor deficits. In ankylosing spondylitis, imaging findings of the facet joints are useful not only for diagnosis but also for monitoring structural changes. In septic arthritis of the facet joints, an early diagnosis at MRI is essential. Gout and metabolic diseases are best evaluated at dual-energy CT, which allows the depiction of crystals. Traumatic dislocations of facet joints are usually unstable injuries that require internal reduction, fixation, and fusion and can be well assessed at CT with three-dimensional reconstructions. Facet joint neoplasms like osteoid osteoma, plasmacytoma, tenosynovial giant cell tumor, and osteochondroma are best evaluated at CT or MRI. The authors provide an overview of key imaging features of the most common facet joint disorders along with anatomic tips and illustrative cases. Acknowledging key imaging findings for the differential diagnosis of facet joint disorders plays a crucial role in the diagnostic accuracy and proper treatment approach for such entities. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Julia E C Anaya
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Silmara R N Coelho
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Atul K Taneja
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Fabiano N Cardoso
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - Abdalla Y Skaf
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
| | - André Y Aihara
- From the Division of Musculoskeletal Radiology, Laboratório Delboni Auriemo, Diagnósticos da América SA (DASA), R. Dr. Diogo de Faria 1379, Vila Clementino, São Paulo, SP 04037-005, Brazil (J.E.C.A., S.R.N.C., A.K.T., F.N.C., A.Y.S., A.Y.A.); Division of Musculoskeletal Radiology, Alta Diagnósticos, São Paulo, Brazil (J.E.C.A., S.R.N.C., A.K.T., A.Y.S.); Musculoskeletal Imaging Division, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.K.T.); Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil (F.N.C., A.Y.A.); Division of Musculoskeletal Radiology, Hospital do Coração (HCor), São Paulo, Brazil (A.K.T., A.Y.S.); and Teleimagem, São Paulo, Brazil (A.K.T., A.Y.S.)
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