Neurological injury in thoracolumbar burst fractures

Abstract

Many authors recommend surgery to remove retropulsed bone fragments from the canal in burst fractures to 'decompress' the spinal canal. We believe, however, that neurological damage occurs at the moment of injury when the anatomy is most distorted, and is not due to impingement in the resting positions observed afterwards. We studied 20 consecutive patients admitted to our spinal injuries unit over a two-year period with a T12 or L1 burst fracture. There was no correlation between bony or canal disruption and the degree of neurological compromise sustained but there was a significant correlation between the energy of the injury (as gauged by the Injury Severity Score) and the neurological status (p < 0.001). This suggests that neurological injury occurs at the time of trauma rather than being a result of pressure from fragments in the canal afterwards and questions the need to operate simply to remove these fragments.

Laminar Fractures as a Severity Marker in Burst Fractures of the Thoracolumbar Spine

“…[24][25][26][27][28] Only a few studies used these scores in isolated burst fractures of the thoracolumbar spine. 5,8,29,30 In our study, the presence of laminar fractures in patients with burst fractures of the thoracolumbar spine was associated with higher ISS and NISS values, consistent with other studies on similar fractures caused by blunt trauma secondary to diverse aetiologies. 8,31,32 Both the ISS and NISS are not appropriate markers for the presence of lamina fractures, because the ranges of both scores were wide in patients without laminar fractures.…”

“…3 The energy of trauma determines the severity of the injury and therefore can be measured indirectly by the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). [4][5][6] In burst fractures of the thoracolumbar spine, the narrowing of the spinal canal caused by bone fragments of the vertebral body (frequently associated with neurological deficits) is considered the best indirect measurement of the energy of trauma. 7,8 Nonetheless, the exact impact of an associated laminar fracture as an isolated severity marker remains unknown.…”

Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise?

“…Limb et al 19 suggest that the static image of the canal obtained by the computerized tomography scans hours or days after the injury does not necessarily re¯ect the displacement at the time of injury, which is what determines the initial neurological insult. The degree of spinal canal narrowing re¯ects the ®nal resting position of the vertebral body fragments after the trauma.…”

Nonoperative versus Operative Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficit: A Meta-analysis

“…Approximately 50% of thoracolumbar burst fractures have an associated neurologic deficit, with the deficit predominantly occurring at the time of injury [9,20,28]. Burst fractures are radiographically characterized by posterior vertebral body angle exceeding 100°, reduction in posterior vertebral height, widened interpedicle distance, posterior cortical line disruption, and posterior vertebral body break, which may be associated with varying degrees of canal stenosis [6,25].…”