Analysis of the independent risk factors of neurologic deficit after thoracolumbar burst fracture

Abstract

BackgroundThe objective of this study is to identify the independent risk factors of neurologic deficit after thoracolumbar burst fracture. Traumatic fractures of the thoracolumbar spine are the most common type of spinal column fractures. Many studies have attempted to determine whether neurologic deficit in such fractures is related to spinal canal stenosis or other parameters observed on axial computed tomography. However, this relationship remains controversial.MethodsA review of the clinical data and axial computed tomography (CT) for 105 patients was performed. Neurologic deficit was classified according to the American Spinal Injury Association (ASIA) classification. Various preoperative CT parameters, including vertebral body compression, canal stenosis, sagittal alignment, and fragment reverse, were analyzed using ordinal logistic regression analysis.Results Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, canal volume, transverse canal diameter, median sagittal diameter, Cobb angle, compression ratio of the sagittal diameter, compression ratio of the cross-sectional area, and compression ratios of the anterior vertebral height (AVH), middle vertebral height (MVH), and posterior vertebral height (PVH) were significantly associated with severity of nerve injury (P < 0.05). However, flip angle and rotation angle of bony fragments were unrelated to severity of nerve damage. Multivariate logistic regression identified AO classification, compression ratio of median sagittal diameter, anterior vertebral compression ratio, and distance from the posterior margin to the vertebral body above to be independent variables associated with neurologic deficit.ConclusionsThe four CT parameters most strongly associated with neurologic deficit in thoracolumbar burst fractures are AO classification, compression ratio of median sagittal diameter, anterior vertebral compression ratio, and distance from the posterior margin to the vertebral body above.

The association between vertical laminar fracture and recurrent kyphosis after implant removal of Thoracolumbar burst fracture: a retrospective study

“…The thoracolumbar burst fracture is characterized by a falling height on the anterior margin of the vertebral body and damage to the posterior margin of the vertebral body. Upon encroachment of the posterior vertebral wall and posterior ligamentous complex, the posteriorly displaced fracture fragment encroaches into the spinal canal [ 18 , 19 ] with a high risk of neurological impairment [ 20 ]. Mohamed M. Aly et al [ 21 ] showed that the absence of horizontal laminar fracture, spinous process fracture, interspinous widening > 4 mm, and facet joint malignment has a high negative predictive value of PLC injury.…”

Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis on the Anterior and Posterior Approaches

“…Regarding neurological outcomes, our study found no significant differences among both approaches. Despite the fact that the surgical procedure aims to improve the patient's neurological status and avoid deterioration, to ensure an increase in the quality of life, it is noteworthy that the initial lesion itself is the main cause of decreased quality of life after BFs 9 and that certain computed tomography parameters (compression ratio of median sagittal diameter, anterior vertebral compression ratio, among others) observed before surgery have a strong association with the neurological deficit 32 .…”

Spinal canal invasion as a predictor of neurological deficit in traumatic vertebral burst fractures

“…[8,9] is negative association has been explained by different theories including the different reserve capacity in the lumbar versus cervical/thoracic spine, the presence of the cauda equina nerve roots in the lumbar spine versus cervical/thoracic cord, and the energy/force resulting in different levels of spinal fractures. [3,[11][12][13][14] No correlation between the extent of spinal canal stenosis and the degree of the neurological deficit [4] (Contd...) Compression ratio of median sagittal diameter as risk factor of neurologic deficit after thoracolumbar burst fracture [12] C: Cervical, L: Lumbar, T: oracic, TL: oracolumbar, MR: Magnetic resonance, PR: Plain radiography, CT: Computed tomography…”