Neurologic injury and recovery in patients with burst fracture of the thoracolumbar spine

Study Design. A retrospective study of factors affecting neural deficits and recovery in burst fracture of the thoracolumbar spine with an evaluation of the computed tomography scans and Frankel grades of 148 consecutive cases. Objectives. To evaluate the relation between the degree of traumatic canal impingement and neurologic improvement. Summary of Background Data. Previous studies on this subject have been reported, but the results have varied. Methods. From 1986 to 1993, 148 consecutive cases of burst fracture of the thoracolumbar spine were evaluated by studying the following: I)the cross-sectional area of the spinal canal by computed tomography scans, 2) damage to the posterior element of injured vertebra by computed tomography scans, 3) the neurologic deficits and improvement by Frankel grade. Results. The average percentage of canal compromise was higher in the patients with neurologic deficit (52%) than in the patients with no neurologic deficit (35%). The degree of neurologic impairment was higher in the group with disruption of the posterior elements (62.9%) than in the group with intact posterior elements (29.8%). The degree of neural improvement was greater in the group with disruption of the posterior elements (60.7%) than in the group with no disruption of the posterior elements (25%). These differences were statistically significant (P < 0.05). Conclusion. The disruption of posterior elements indicated a more significant neurologically injured status on first examination; in those cases, however, the presence of disrupted posterior elements indicated a high possibility of neurologic recovery.