Neurological Deficit and Canal Compromise in Thoracolumbar and Lumbar Burst Fractures

Mohanty, S. P.; Bhat, Nitin; Abraham, Ruben; Keerthi, C Ishwara

doi:10.1177/230949900801600105

Cited by 38 publications

(22 citation statements)

References 16 publications

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“…The global death rate varies from 6.8% to 28% in some literature, and once matched with parallel trauma patients deprived of cervical spine injury and persons with cervical damage are more expected to expire in the emergency section or admitted to the intensive care unit (ICU) (58,59).…”

Section: Discussionmentioning

confidence: 99%

An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

et al. 2017

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Context: The incidence of vertebral column and spinal cord damage in children in the current century is greater than ever. Thoracolumbar fractures are extra numerous in teenagers, the most common reasons are falling from a height and motorcycle accidents. The current study aimed at designing a straightforward assessment of the epidemiology, anatomy, biomechanics, and clinical detection and managing plans for children with thoracolumbar traumas. Evidence Acquisition: Totally, 85 articles conducted from 1970 to 2016 were studied. A total of 63 articles were included in the current pediatric evaluation. But, based on the philosophy of the current study, just newly published studies from 2000 on spinal trauma epidemiology, classification, and management were included. Results: Spinal fractures in pediatrics characterize 1% or 2% of all pediatric fractures, and most of the damage comprise the cervical spinal column. The mainstream of thoracolumbar spinal column fractures in the children happen at the age of 14 to 16 years. The most common damaged zone of the spine is T4 to T12, followed by T12 to L2 based on the patients' age and type of radiologic classification of trauma, and conservative or surgery treatments may be used for the fractures. Conclusions: Forceful use of computed tomography (CT) scan and magnetic resonance imaging (MRI) can classify delicate thoracolumbar damages and involvement of neural components and offer prognostic data in children with possible neurologic recovery, especially in SCIWORA (spinal cord injury without radiographic abnormality) type of injury. Currently, classification of the thoracolumbar injury and severity scales (TLISS) is generally useful in the adults by means of trauma to define non-operative vs. operative management of spine fractures. This classification is newly considered in the pediatric population, and there are reports on the outstanding validity of this system, similar to adults. Usually, various stable fractures can be cured conservatively, while unstable fractures need surgical stabilization.

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Section: Discussionmentioning

confidence: 99%

An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

et al. 2017

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“…Other imaging parameters have been shown in several other studies to be useful in predicting the severity of neurologic deficit after thoracolumbar burst fracture [11, 12]. In contrast, in 2008, Mohanty et al found no association between the extent of canal stenosis and the severity of neurologic deficit [9]. Moreover, they found a significant correlation between thoracic spine, rather than L1, and the severity of neurologic deficit.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…Sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) are the most accepted measurement techniques to assess the radiological characteristics of thoracolumbar burst fractures. [8910111213]…”

Section: Introductionmentioning

confidence: 99%

The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures

Yüksel

Gürbüz

Gok

et al. 2016

Journal of Neurosciences in Rural Practice

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Aim:Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures.Materials and Methods:Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed.Results:There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI <20°, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values.Conclusion:SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.

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Neurological Deficit and Canal Compromise in Thoracolumbar and Lumbar Burst Fractures

Abstract: When studying neurological deficit, T11 and T12 injuries should be analysed separately from L1 injuries.

Cited by 38 publications

References 16 publications

An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

An Update Review of Epidemiology, Anatomy, Classification, Management and Outcome of pediatric Thoracolumbar Spine Trauma

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

The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures

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