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Study design <p>retrospective single-center study.</p> Purpose <p>To compare the accuracy of various methods to measure interspinous widening (ISW) on computed tomography (CT) in detecting posterior ligamentous complex (PLC) injuries on magnetic resonance imaging (MRI) for thoracolumbar fractures (TLFs).</p> <p>Overview of literature: ISW showed varying accuracy in detecting PLC injury on MRI due to the lack of standardized methods of measurement.</p> Methods <p>We retrospectively reviewed data of 215 consecutive patients with acute TLFs (T1–L2). Three reviewers evaluated MRI and CT images. We measured four ISW parameters: (1) supraspinous distance (SSD): distance between the most posterior aspect of the two spinous processes; (2) midspinous distance (MSD): between the midpoints of the spinous processes; (3) interlaminar distance (ILD): between the most anterior aspect of lamina; and (4) interspinous angle (ISA): the angle between the two spinous processes. For SSD, MSD, and ILD, four different measurements were calculated according to the reference, either the average of upper and lower adjacent levels or whether a ratio or absolute value was used. We compared the diagnostic accuracy of various methods of ISW measurement in detecting black stripe discontinuity on MRI using the area under the receiver operating characteristic curve (AUC) and interobserver reliability using interclass correlation (ICC).</p> Results <p>All ISW methods showed low accuracy as denoted by AUC &lt; 0.70 (range 0.51–0.65). At the optimum threshold, there was a trend toward higher specificity and lower sensitivity. The ICC was poor for 2 measurements, moderate for 5 measurements, and good for 5 measurements.</p> Conclusions <p>This study demonstrates the limited accuracy of ISW methods in detecting PLC injury on MRI. However, ILD showed a trend toward better accuracy; there was no statistically significant difference between all methods. Therefore, ISW, or the lack thereof, especially when isolated, should be interpreted with caution as an indicator for PLC injury.</p>

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Diagnostic accuracy of various methods for measuring interspinous widening in thoracolumbar posterior ligamentous complex injury shown on MRI

  • 期刊论文

  • 发表日期：

    2026年7月11日

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  • Mohamed M. Aly,
  • Meshari M. Almutairi,
  • Waleed Almohammadi,
  • Areej Al Fattani,
  • Abdulaziz Alkhoshi,
  • Abdulbaset M. Al-Shoaibi

摘要

Study design

retrospective single-center study.

Purpose

To compare the accuracy of various methods to measure interspinous widening (ISW) on computed tomography (CT) in detecting posterior ligamentous complex (PLC) injuries on magnetic resonance imaging (MRI) for thoracolumbar fractures (TLFs).

Overview of literature: ISW showed varying accuracy in detecting PLC injury on MRI due to the lack of standardized methods of measurement.

Methods

We retrospectively reviewed data of 215 consecutive patients with acute TLFs (T1–L2). Three reviewers evaluated MRI and CT images. We measured four ISW parameters: (1) supraspinous distance (SSD): distance between the most posterior aspect of the two spinous processes; (2) midspinous distance (MSD): between the midpoints of the spinous processes; (3) interlaminar distance (ILD): between the most anterior aspect of lamina; and (4) interspinous angle (ISA): the angle between the two spinous processes. For SSD, MSD, and ILD, four different measurements were calculated according to the reference, either the average of upper and lower adjacent levels or whether a ratio or absolute value was used. We compared the diagnostic accuracy of various methods of ISW measurement in detecting black stripe discontinuity on MRI using the area under the receiver operating characteristic curve (AUC) and interobserver reliability using interclass correlation (ICC).

Results

All ISW methods showed low accuracy as denoted by AUC < 0.70 (range 0.51–0.65). At the optimum threshold, there was a trend toward higher specificity and lower sensitivity. The ICC was poor for 2 measurements, moderate for 5 measurements, and good for 5 measurements.

Conclusions

This study demonstrates the limited accuracy of ISW methods in detecting PLC injury on MRI. However, ILD showed a trend toward better accuracy; there was no statistically significant difference between all methods. Therefore, ISW, or the lack thereof, especially when isolated, should be interpreted with caution as an indicator for PLC injury.