Pathologic correlation of posterior ligamentous injury with MRI

This article describes 2 cases of spinal trauma in which diagnostic magnetic resonance imaging (MRI) was correlated with histopathology for diagnosis of a posterior ligamentous complex injury. Spine fractures are common and represent up to 16% of traumatic fractures. Diagnostic imaging currently involves plain films and computerized tomography, but MRI is being used with increasing frequency. The definition of neurologic tissue injury has had substantial documentation in the spinal literature. Clinically, posterior ligamentous complex injury has been associated with facet disruption, gapping of the spinous processes, and significant kyphosis. Assessment of spinal stability in the spine trauma population is based significantly on the assumed disruption or integrity of the posterior ligamentous complex. High signal intensity in the area of the ligamentum flavum and interspinous ligament on fat-saturated T2 MRIs has been associated with the clinical finding of interspinous ligament disruption noted at surgical exploration. Magnetic resonance imaging in spine trauma is widely accepted despite a paucity of data addressing its histopathologic accuracy. To our knowledge, histopathologic correlation of MRI of ligamentous injuries has not been reported.