The lumbar posterior ligamentous complex (PLC) includes the supraspinous ligament, interspinous ligaments, ligamentum flavum, and lumbar facet capsules. Its integrity determines lumbar fracture stability classification.
Provides the posterior tension band resisting lumbar flexion distraction, determines fracture stability in the TLISS (Thoracolumbar Injury Classification and Severity Score), and must be assessed in all thoracolumbar trauma.
TLISS assigns 3 points to PLC disruption — the highest weighting in the classification, reflecting the critical importance of posterior ligamentous integrity for spinal stability. MRI demonstrates PLC disruption as posterior fluid signal (T2 hyperintensity).
MRI-confirmed posterior ligamentous complex injury assigning 3 points in TLISS, typically indicating surgical stabilisation by posterior instrumented fusion.
Flexion-distraction Chance fracture disrupting the PLC either through bone (bony Chance, more stable) or through ligaments (ligamentous Chance, more unstable), with ligamentous type requiring posterior fusion.
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