Use of Computed Tomography Compression Ratio in Diagnosis of Disc Injuries and Posterior Ligamentous Complex Injuries in Osteoporotic Thoracolumbar Compression Fractures

Background: Osteoporotic compression fractures are common among the elderly. It is important to predict the posterior ligamentous complex (PLC) and disc injuries in computed tomography (CT) scans of patients with magnetic resonance imaging (MRI) contraindications. Objectives: To determine the role of the CT compression ratio (CTCR) in diagnosing PLC and disc injuries and to compare it with the loss of vertebral body height (LOVBH) in osteoporotic thoracolumbar compression fractures. Patients and Methods: A total of 91 consecutive patients with vertebral fractures were included as the study population. The PLC and disc injuries were assessed using MRI, and the following radiological parameters were determined based on CT scans for further MRI examinations: CTCR, LOVBH, local kyphosis (LK), interspinous widening (ISW), vertebral translation (VBT), and posterior structures fractures (PSF). Statistical analysis was performed to identify the diagnostic value of CT features in PLC and disc injuries. Results: The PLC injuries were detected in 9/91 cases, and the number of disc injuries was 47/91. Neither CTCR nor LOVBH was associated with PLC injuries (P > 0.05). However, the CTCR was associated with disc injuries (P < 0.05), with an optimal threshold of 1.755 (sensitivity, 68.1%; specificity, 79.5%), while the LOVBH was not significantly associated with disc injuries. Based on the results, VBT was significantly related to PLC and disc injuries (P < 0.05). Conclusion: The injured vertebral CTCR was associated with disc injuries rather than PLC injuries, suggesting that compression fractures are relatively stable with less PLC injury. Overall, CTCR is a useful indicator reflecting the compression degree of the injured vertebrae; it is also a valid predictor of disc injuries.