• Karthik Ramachandran, Ajoy Prasad Shetty, Sindhiya Dhanapaul, Raksha P Algeri, Pushpa Bhari Thippeswamy, Rishi Mugesh Kanna, and Rajasekaran Shanmuganathan.
• Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
• World Neurosurg. 2023 May 13.

ObjectiveAlthough magnetic resonance imaging is the primary modality of investigation for determining the extent of posterior ligamentous complex (PLC) injuries in lower lumbar fractures (LLF) (L3-L5), the reliability of computed tomography (CT) has not been well defined. The main objective of this study is to analyze the diagnostic accuracy of combined CT findings for detecting PLC injury in patients with LLF.MethodsWe retrospectively analyzed data from 108 patients who presented with traumatic LLF. CT parameters like loss of vertebral body height, local kyphosis, retropulsion of fracture fragment, interlaminar distance, interspinous distance, supraspinous distance, interpedicular distance, canal compromise, facet joint diastasis in axial images (FJDA) and facet joint diastasis in sagittal images (FJDS), and presence of lamina and spinous process fracture were calculated using axial and sagittal CT images. The presence or absence of PLC injury was determined using magnetic resonance imaging as a reference standard.ResultsAmong 108 patients, PLC injury was identified in 57 (52.8%). On univariate analysis, local kyphosis, retropulsion of fracture fragment, interlaminar distance, interpedicular distance, FJDS, FJDA, and the presence of spinous process fracture were found to be significant (P < 0.05) in predicting PLC injury. Whereas on multivariate logistic regression analysis, FJDS (P = 0.039) and FJDA (P = 0.003) were found to be variables independently associated with PLC injury.ConclusionsAmong the various CT parameters, facet joint diastasis (FJDS > 4.2 mm and FJDA > 3.5 mm) is the most reliable factor in determining PLC injury.Copyright © 2023 Elsevier Inc. All rights reserved.

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