Diagnostic Accuracy of Ultrasonography for Detecting Posterior Ligamentous Complex Injuries of Thoracolumbar Trauma: An Updated Systematic Review With Meta-Analysis

Abstract

Study Design: Systematic review with meta-analysis. Objective: This study aimed to assess the diagnostic accuracy of USG for detecting PLC injuries. Methods: A systematic search was conducted in PubMed, EMBASE, and Web of Science. Studies evaluating USG images compared with MRI or intraoperative findings for PLC injuries were included. Pooled sensitivity, specificity, and area under the ROC curve (AUC) were calculated using a bivariate model. Methodological quality was assessed using QUADAS-C, and publication bias was evaluated via Deeks’ test. Results: Six studies comprising 140 patients were included. The pooled sensitivity and specificity of USG were 0.86 (95% CI: 0.73-0.93) and 0.95 (95% CI: 0.81-0.99), respectively, with an AUC of 0.91 (95% CI: 0.88-0.93). Moderate heterogeneity was observed in specificity (I2 = 51.89%), and publication bias was detected (Deeks’ test, P < 0.001). Conclusions: Ultrasonography shows good diagnostic performance for detecting thoracolumbar PLC, particularly involving the supraspinous and interspinous ligaments. However, its role in assessing deeper structures such as the ligamentum flavum and facet joint capsules remains inadequately validated. Therefore, USG should be considered a complementary tool, especially where MRI is unavailable or contraindicated, and further studies are required to broaden its clinical applicability.