Correlation between Interpedicular Distance to Severity Of Thoracolumbar Spine Burst Fractures - A Prospective Study

Abstract

Introduction: Burst fractures resulting from axial compression with rupture of the anterior and medial structures of the vertebral body with retropulsion of a bone fragment into the spinal canal and an increase in the interpedicular distance account for more than half of all thoracolumbar fractures which often cause neurologic deficits. Objective: To study correlation between interpedicular distance and the severity of thoracolumbar burst fractures on neurological out come with respect to Time from injury to presentation , neurological assessment at presentation,grading of patients according to Frankel grading , imaging of patient with the help of X-rays, CT scan and MRI, interpedicular distance of burst fracture vertebra preoperatively and post operatively. Materials and methods: In our study, 60 patients with thoracolumbar spine burst fractures with neurodeficits were investigated with respect to preoperative and post operative interpedicular distance and were treated with posterior pedicular screw fixation from August 2012 to August 2013 with a follow up period of at least 6 months. Results: Our study found that 28 patient’s Computed tomography ( CT scan) showed change in preoperative and postoperative interpedicular distance while 32 patients had no change in interpedicular distance postoperatively. Among patients showing a change in interpedicular distance (n=28), 8 ( 28.57%) cases showed neurological recovery while 20 ( 71.43 %) patients did not have any neurological recovery at latest follow up. While among 32 patients who did not have any change in interpedicular distance , 14 (43.75%) patients had neurological improvement while 18(56.25%) patients did not show any neurological improvement in Frankel grading at latest follow up. The P value for correlation between interpedicular distance and severity of thoracolumbar burst fractures in relation to neurological outcome is 0.38 ( Chi square test = 0.74) i.e. >0.05 hence the neurological outcome is not statistically significant with changes in interpedicular distance . Conclusion: To conclude, our prospective study of 60 thoracolumbar burst fractures, proposes that change in an interpedicular distance is not significantly correlated with neurological outcome in thoracolumbar bursts fractures .The initial neurological damage at moment of impact is the major factor on which the final neurological outcome depends.