Stability of the Thoracic and Lumbar Spine in Traumatic Paraplegia following Fracture or Fracture-Dislocation

Abstract

Twenty-five patients with traumatic paraplegia as a result of fracture or fracture-dislocation of the thoracic and lumbar spine were studied. No injuries of the cervical spine were included. A simple classification of the injuries based on roentgenographic findings is proposed. The classification may be useful for determining spinal stability and predicting the likelihood of progressive spinal deformity. The occurrence of spinal deformity may cause late complications which compromise the rehabilitation of the paraplegic patient. In this series the compression-burst (Type II) fractures were stable and spontaneous interbody fusion frequently occurred. Surgical stabilization is not indicated for these injuries. In contrast, the rotational fracture-dislocations (Type-III fractures) were seldom stable and were often followed by progressive deformity, with vertebral-body fusion occurring only rarely. A high incidence of late complications consequent to progressive deformity was noted in this series as in others. Accurate reduction, internal fixation, and bone-grafting are recommended for injuries in this category. There is less certainty regarding the wedge-compression (Type I) fractures. Our experience has been limited, but this fracture would appear not to be as stable or as benign as is the similar appearing fracture in the patient without neurological injury. Three of five injuries in this series resulted in instability and would have been better managed by surgical stabilization. The goal of treatment in all fractures or fracture-dislocations of the thoracic and lumbar spine should be to re-establish and maintain normal vertebral alignment. Achievement of this goal requires surgical stabilization of the spine with a Type-III fracture, especially when the fracture is near the thoracolumbar junction.