Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic spinal cord injury.

Abstract

To identify specific morphological characteristics in thoracolumbar burst fractures associated with neurological outcome after severe traumatic spinal cord injury (TSCI). We retrospectively analyzed the clinical and radiological (CT scan morphological characteristics) data of 25 consecutive patients admitted for TSCI secondary to a burst fracture at levels from T11 to L2 between 2010 and 2017 in single level-1 trauma center. We included severe TSCI, defined as American Spinal Injury Association Impairment Scale (AIS) grade A, B or C. Among the 25 patients with severe TSCI, 14 were AIS A, 5 were AIS B, and 6 were AIS C upon initial preoperative neurological evaluation. The AIS grade and the burden of associated injuries (Injury Severity Score, ISS) were the only clinical factors significantly associated with poor neurological recovery. The trauma level of energy was not associated with neurological outcome. Several fractures parameters were independently related to neurological recovery: the postero-inferior corner translation, presence of retropulsed fragment comminution and complete lamina fracture. The magnitude of sagittal kyphosis angle, vertebral kyphosis index and vertebral body comminution were not associated with the neurological outcome. Morphological features of the bony structures involving the spinal canal in thoracolumbar burst fractures with severe TSCI are associated with the chronic neurological outcome and could provide more insight than the AIS clinical grading. The fracture pattern may better reflect the actual level of energy transferred to the spinal cord than distinguishing between low- and high-energy trauma.