Spinal Canal Compromise Research Articles

Functional Outcomes After Surgery for Spinal Fractures: Return to Work and Activity

The literature regarding surgical treatment's impact on patient function after spinal fracture is sparse. Some authors have speculated that operative injury--the dissection of paraspinous muscle tissue, damage to spinal motion segments, implantation of spinal devices--may impair functional recovery in spine trauma patients. Nonoperative care has produced satisfactory results in some hands, but results are difficult to reproduce, treatment is resource-intensive, and functional outcomes are poorly documented. This study reports return to work and functional recovery in a 5-year follow-up of severely injured patients treated with segmental spinal instrumentation. Seventy consecutive patients treated with Cotrel Dubousset instrumentation for unstable thoracic, thoracolumbar, and lumbar spine fractures were followed-up. All had high-energy trauma and were admitted directly to a level 1 university trauma center; 38% were polytraumatized; and 56% had neurologic injuries. Indications for surgery included: (1) segmental instability; (2) incomplete or progressive neurologic injuries with residual spinal canal compromise; (3) concomitant injuries precluding cast treatment; and (4) polytrauma. Two patients died and six were lost to follow-up, leaving 62 (91%) for assessment at a mean 5-year follow-up (range 2-8 y). Clinical outcome has been reported. Functional recovery was assessed based on return to work, level of work, and level of daily activity. Despite the severity of spinal and concomitant injuries, 70% of patients returned to full-time work and another 8% were considered capable: 54% to their previous level of employment without restrictions and 16% to full-time, but lighter, jobs. Twenty-two percent were working part-time or not at all, and 8% were unemployed despite unrestricted functional status. Work status correlated directly with neurologic impairment (P < 0.00005) and was not related to level of injury, hardware failure, extent of surgical dissection, or construct pattern. Of patients with limitations, 18% were limited by pain and 27% by neurologic injury. Neurologic injury had a greater impact on functional outcome than any other variable. Patients limited by pain were more often impaired by residual radicular and neuropathic symptoms than by back pain. Impairment was not related to the extent of either the surgical incision or the instrumentation. Patients with persistent back pain generally had an identifiable and correctable mechanical problem-sagittal imbalance, pseudarthrosis, or persistent instability--as the underlying cause. Our series of trauma patients was predominantly young and male. Among this cohort, individual characteristics of occupation (often physical laborers and craftsmen) and judgment (criminal convictions and incarceration) may have restricted opportunities for re-employment in 40% of the entire study group.

Embolization of sacral tumors.

The management of sacral tumors is challenging because of difficulties in accessing the lesion, the high rate of local recurrence, extensive vascularity causing significant intraoperative blood loss, resistance to radiation therapy, and risk of malignant transformation. Although surgery is the main treatment for many sacral tumors, embolization is a valuable primary and adjunctive therapy. Patients with benign lesions, including aneurysmal bone cysts and giant cell tumors, have responded to embolization with resolution of their symptoms and with ossification of their lesions. Embolization is used as a primary therapy for metastatic lesions and results in neurological improvement, reduced tumor size, and decreased spinal canal compromise. It is also used as an adjuvant therapy to reduce intraoperative blood loss and to aid in the resection of benign, malignant, and metastatic sacral lesions. It is important to note that embolization techniques are a valuable resource in the treatment of sacral tumors, and, overall, embolization should always be considered in patients with sacral tumors.

Neurologically Intact Fracture-Dislocations of the Thoracolumbar Spine

Purpose: In this study, we presented ten neurologically intact fracture-dislocations of the thora-columbar spine which are extremely rare, and reported the results of treatment. Methods: Ten fracture-dislocations of the thoracolumbar spine were treated in a period of nine years. Surgical reduction and stabilization were performed in six patients. Four patients rejected surgery and were treated conservatively. The average follow-up was 55 months. Results: During the conservative course of treatment, surprisingly, the neurologic status did not deteriorate. However, varying degrees of pain and roentgenographic deterioration of spinal alignment and canal compromise were detected. In the operated group, there were also no deteriorations in the neurologic status and the roentgenograms revealed no serious loss of reduction. One of the patients from the conservative group and two of the patients from the operative group were able to return to their pre-injury works. Conclusion: Surgical treatment was satisfactory, both clinically and radiologically, in a group of patients with thoracolumbar fracture-dislocations. Well-known drawbacks of conservative treatment, including long-term bed-rest, social and economic losses and long-lasting treatment, led us to favor surgical treatment.

NEUROLOGICALLY INTACT FRACTURE-DISLOCATIONS OF THE THORACOLUMBAR SPINE

Purpose: In this study, we presented ten neurologically intact fracture-dislocations of the thora-columbar spine which are extremely rare, and reported the results of treatment. Methods: Ten fracture-dislocations of the thoracolumbar spine were treated in a period of nine years. Surgical reduction and stabilization were performed in six patients. Four patients rejected surgery and were treated conservatively. The average follow-up was 55 months. Results: During the conservative course of treatment, surprisingly, the neurologic status did not deteriorate. However, varying degrees of pain and roentgenographic deterioration of spinal alignment and canal compromise were detected. In the operated group, there were also no deteriorations in the neurologic status and the roentgenograms revealed no serious loss of reduction. One of the patients from the conservative group and two of the patients from the operative group were able to return to their pre-injury works. Conclusion: Surgical treatment was satisfactory, both clinically and radiologically, in a group of patients with thoracolumbar fracture-dislocations. Well-known drawbacks of conservative treatment, including long-term bed-rest, social and economic losses and long-lasting treatment, led us to favor surgical treatment.

Intraoperative Somatosensory Evoked Potential Findings in Acute and Chronic Spinal Canal Compromise

Early and long-term postoperative outcome were analyzed by retrospective record review and compared with results of intraoperative somatosensory evoked potential (SEP) findings in 70 patients with chronic lumbar stenosis. Adverse SEP changes occur in up to 2% of patients during scoliosis surgery and may reverse with intraoperative intervention. Little is known about the short- or long-term results of intraoperative intervention based on adverse SEP changes in patients with chronic lumbar stenosis during lumbar decompression and fusion. To compare intraoperative SEP changes with immediate and long-term neurologic outcome in patients undergoing lumbar decompression, instrumentation and fusion for chronic lumbar stenosis and to determine whether the early correlation between intraoperative SEP deterioration and clinical outcome persisted. Monitoring SEPs using an alternating arm and leg stimulation paradigm allowed rapid identification of intraoperative changes. Retrospective record review was conducted without knowledge of intraoperative SEP findings. Clinical and SEP findings were then compared, to determine whether the strong association between intraoperative SEP results and early clinical outcome persisted. Nine of 12 patients who had unilateral intraoperative SEP deterioration that resolved with intervention had no adverse sequelae; the remaining three had new ipsilateral weakness that persisted during a 9-24-month follow-up. Intraoperative SEPs deteriorated in 15% of patients with normal and abnormal baseline SEPs. Intraoperative SEP deterioration could not be predicted by preoperative radicular pain, focal symptomatology or baseline SEP findings. 80% of patients with normal SEPs but only 54% with abnormal SEPs had immediate and sustained pain relief. SEP deterioration that reversed with surgical intervention or high-dose steroids resulted in no adverse neurologic outcome. Acute, unilateral, unresolved intraoperative SEP deterioration was associated with long-term ipsilateral weakness not predicted by clinical or neurologic findings before surgery. Clinical improvement persisted in 92% of patients, 4% were unchanged, and 4% had persistent neurologic changes during an average 12-month follow-up period. The findings underscore the need for monitoring SEPs during surgery in all patients undergoing invasive lumbar surgery and for rapid identification and intervention should a unilateral SEP change persist.

Tracheo-Innominate Artery Fistula After Tracheostomy

Tracheo-Innominate Artery Fistula After Tracheostomy

The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: Results of a multicenter study.

A multicenter, retrospective study using computed tomographic and magnetic resonance imaging data to establish quantitative, reliable criteria of canal compromise and cord compression in patients with cervical spinal cord injury. To develop and validate a radiologic assessment tool of spinal canal compromise and cord compression in cervical spinal cord injury for use in clinical trials. There are few quantitative, reliable criteria for radiologic measurement of cervical spinal canal compromise or cord compression after acute spinal cord injury. The study included 71 patients (55 men, 16 women; mean age, 39.7 +/- 18.7 years) with acute cervical spinal cord injury. Causes of spinal cord injury included motor vehicle accidents (n = 36), falls (n = 20), water-related injuries (n = 8), sports (n = 5), assault (n = 1), and farm accidents (n = 1). Canal compromise was measured on computed tomographic scan and T1- and T2-weighted magnetic resonance imaging, and cord compression at the level of maximum injury was measured on T1- and T2-weighted magnetic resonance imaging. All films were assessed by two independent observers. There was a strong correlation of canal compromise and/or cord compression measurements between axial and midsagittal computed tomography, and between axial and midsagittal T2-weighted magnetic resonance imaging. Spinal canal compromise assessed by computed tomography showed a significant although moderate correlation with spinal cord compression assessed by T1- and T2-weighted magnetic resonance imaging. Virtually all patients with canal compromise of 25% or more on computed tomographic scan had evidence of some degree of cord compression on magnetic resonance imaging, but a large number of patients with less than 25% canal compromise on computed tomographic scan also had evidence on magnetic resonance imaging of cord compression. In patients with cervical spinal cord injury, the midsagittal T1- and T2-weighted magnetic resonance imaging provides an objective, quantifiable, and reliable assessment of spinal cord compression that cannot be adequately assessed by computed tomography alone.

The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part I: An evidence-based analysis of the published literature.

An evidence-based analysis of published radiologic criteria for assessing spinal canal compromise and cord compression in patients with acute cervical spinal cord injury. This study was conducted to determine whether literature-based guidelines could be established for accurate and objective assessment of spinal canal compromise and spinal cord compression after cervical spinal cord injury. Before conducting multicenter trials to determine the efficacy of surgical decompression in cervical spinal cord injury, reliable and objective radiographic criteria to define and quantify spinal cord compression must be established. A computer-based search of the published English, German, and French language literature from 1966 through 1997 was performed using MEDLINE (U.S. National Library of Medicine database) to identify studies in which cervical spinal canal and cord size were radiographically assessed in a quantitative manner. Thirty-seven references were included for critical analysis. Most studies dealt with degenerative disease, spondylosis, and stenosis; only 13 included patients with acute cervical spinal cord injury. Standard lateral radiographs were the most frequent imaging method used (23 studies). T1- and T2-weighted magnetic resonance imaging were used to assess spinal cord compression in only 7 and 4 studies, respectively. Spinal cord size or compression were not precisely measured in any of the cervical trauma studies. Interobserver or intraobserver reliability of the radiologic measurements was assessed in only 7 (19%) of the 37 studies. To date, there are few quantitative, reliable radiologic outcome measures for assessing spinal canal compromise or cord compression in patients with acute cervical spinal cord injury.

Surgical treatment for acute spinal cord injury study pilot study #2: evaluation of protocol for decompressive surgery within 8 hours of injury

Acute spinal cord injury (SCI) is a major public health problem for which there is still only limited treatment available. The National Acute Spinal Cord Injury Study-2 (NASCIS-2) and -3 clinical trials demonstrated that the use of acute pharmacotherapy with methylprednisolone can attenuate the secondary injury cascade if administered within 8 hours of acute SCI. However, no trial has been performed to examine whether acute surgical decompressive procedures within this critical 8-hour time window can improve patients' neurological outcome. The purpose of the current prospective Surgical Treatment for Acute Spinal Cord Injury Study (STASCIS) pilot study was to determine the feasibility of obtaining a radiological diagnosis of spinal canal compromise of 25% or more and to perform spinal cord (C3-T1) decompressive procedures by 8 hours postinjury. One of the following three decompressive methods was used: 1) traction alone; 2) traction and surgery; or 3) surgery alone. Twenty-six patients from eight North American centers were entered into the study between 1996 and 1997. Significant difficulties were encountered in many centers in performing immediate magnetic resonance imaging examination in patients with acute SCI. Fewer than 10% of acute cervical SCI patients could be enrolled into this protocol mainly because the combination of the required time for rescue, resuscitation, transport, imaging study, and surgical preparation exceeded the 8-hour injury-to-decompressive surgery window. Eleven patients underwent decompressive procedures initially by being placed in traction at a mean time of 10.9 hours postinjury. Those patients not undergoing this procedure underwent decompressive surgery at a mean time of 40.1 hours. However, the surgical decompressive procedure was completed within 12 hours in seven patients. As a result of these findings, several major changes have been made to the STASCIS protocol for early decompressive therapy.

腰椎高度粉砕骨折の保存療法の小経験

A retrospective review of six patients treated nonoperatively for severe burst fractures of the lumbar spines with mild neurological deficits was performed. In five patients considered to have good functional outcome; kyphotic deformity averaged 10 at injury (-14 to 21) and 3.6 at follow-up (-6-15), and spinal canal compromise averaged 54.4% at injury (46.9-62.0) and 34.1% at follow-up (22.2-42.4). One patient with laminar fracture had a mild back pain, requiring surgery. Nonoperative treatment should be considered an alternative in the treatment of severe burst fractures of the lumbar spine with mild neurological deficit and normal posterior column.

O-6-89 - Osteoplastic laminotomy using titanium microplates. A technique for reconstruction of the laminar roof

Conventional circumferential stabilization for pathologies causing instability of the thoracic spine requires a two or even a three-staged procedure. The authors present their tertiary care center experience of single-staged procedure to establish a circumferential fusion through an extended costotransversectomy approach.To demonstrate neural canal decompression, removal of the pathology, achieve circumferential fusion, and correcting the deformity through a single procedure.Prospective and observational.Forty-six patients with pan thoracic column instability due to various pathologies.Neurologic condition was evaluated using American Spinal Injury Association and Eastern Cooperative Oncology Group grading systems. Outcome was evaluated with regard to the decompression of neural canal, correction of deformity, and neurologic improvement. All patients were evaluated for neural canal compromise and degree of kyphosis preoperatively, early, and late postoperatively.All patients had severe spinal canal compromise (mean, 59%±9%) and loss of vertebral body height (mean, 55%±10%). A single-stage circumferential fusion was performed (four-level pedicle screw fixation along with a ventral cage fixation after a vertebrectomy or corpectomy) through an extended costotransversectomy approach.The pathologies included trauma (21), tuberculosis (18), hemangioma (2), aneurysmal bone cyst (1), recurrent hemangioendothelioma (1), solitary metastasis (1) and plasmacytoma (1), and neurofibromatosis (1). Thirty-five of 46 patients (76%) demonstrated improvement in the performance status. The major complications included pneumonitis (3), pneumothorax (3) and neurologic deterioration (3; improved in two), deep venous thrombosis (2), and recurrent hemoptysis (1). No implant failures were noted on last radiology follow-up. There were two mortalities; one because of myocardial infarction and another because of respiratory complications.The following study demonstrated that extended costotrasversectomy approach is a good option for achieving single-staged circumferential fusion for correcting unstable thoracic spine due to both traumatic and nontraumatic pathologies.

Lumbar radiculopathy associated with anterior intraspinal bony lesions.

Thirty-one patients underwent posterior decompression for anterior intraspinal bony lesions which were causing symptoms. The diagnoses were a displaced apophyseal endplate, vertebral corner bulge, and an ossified posterior longitudinal ligament or disc. Symptoms were caused by associated lumbar disc herniations or by gradual impingement by the bony lesion on neural tissue. The success rate after operation was 84%. Anterior spinal canal compromise by bony lesions can be treated by decompression through a posterior approach with minimal destruction of the laminae and facets.

Musculoskeletal causes of spinal axis compromise: beyond the usual suspects.

The majority of cases of spinal canal compromise are caused by common pathologic conditions, including degenerative spondylosis, infection, trauma, and metastatic disease. However, there are other causes of spinal canal compromise that, though unusual, may be seen in everyday practice. Congenital abnormalities of the spine that may produce spinal canal compromise include the os odontoideum, hemivertebra, diastematomyelia, and achondroplasia. Arthritides and enthesopathies such as rheumatoid arthritis, ankylosing spondylitis, synovial cysts of the facet joint, calcium pyrophosphate dihydrate deposition or hydroxyapatite deposition, and ossification of the posterior longitudinal ligament or ligamentum flavum may lead to narrowing of the spinal canal. Primary spinal tumors and tumorlike lesions such as hemangioma, aneurysmal bone cysts, osteochondroma, and osteoblastoma may also cause spinal canal stenosis. Finally, Paget disease of bone may compromise the spinal cord. Radiologists should be aware of these unusual musculoskeletal causes of spinal canal compromise and their radiologic and clinical features.

Results of the AO spinal internal fixator in the surgical treatment of thoracolumbar burst fractures.

The potential for clinical instability following thoracolumbar fractures has evoked a progressive increase in interest in the surgical treatment of unstable thoracolumbar fractures. From September 1988 to October 1991, 44 thoracolumbar burst fractures were treated surgically by the AO Spinal Internal Fixator at the Orthopaedics and Traumatology Clinics of Ankara Social Security Hospital. Mean follow-up period was 28.8 (range 12-48) months. Fourteen (31.8%) of the patients were female, and 30 (68.2%) were male. Postoperatively, the mean anterior vertebral height loss and spinal canal compromise were corrected by 36.5% and 39.9%, respectively. Also, postoperatively 15.9% of improvement was obtained in the mean kyphosis angle. The mean compression angle, which was 19.5 degrees preoperatively, was corrected by 12.3 degrees and came to an average of 7.1 degrees postoperatively. In light of these data, it is suggested that the AO Spinal Internal Fixator effectively restores three-dimensional alignment of the spine and provides a rigid fixation.

Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy.

A retrospective study was performed to evaluate the radiographic changes that occurred at spinal levels adjacent to fused vertebrae after anterior cervical fusion. One hundred six patients with cervical spondylotic myeloradiculopathy (88 men, 18 women) were followed for an average of 8.5 years. The average age at follow-up was 64 years. Forty-two patients underwent a single-level fusion, 52 had a two-level fusion, and 12 had three levels fused. Seventeen patients who underwent additional surgery after anterior fusion also were reviewed, with an average follow-up period of 2.9 years. Postoperatively, cervical flexion-extension resulted in significantly increased movement about the vertebral interspace at the upper adjacent level. An increment of posterior slip of the vertebra immediately above the fusion level, with associated spinal canal compromise of less than 12 mm, significantly affected neurologic results. Patients with multilevel fusions notably exhibited these radiographic abnormalities at adjacent levels. Spinal canal stenosis, when associated with dynamic spinal canal stenosis in the vertebra above the fusion level, affected late neurologic results. Results of salvage laminoplasty were not satisfactory. Unnecessarily extended longer fusion must be avoided.

Acute injuries of the upper dorsal spine

In an effort to define better diagnostic and treatment criteria, we reviewed the cases of 50 patients with injuries of the upper dorsal spine from T2-T9, seen between January 1983 and July 1988. The majority of injuries were caused by road traffic accidents, followed by falls from a height, and train accidents. More than 50 per cent had associated injuries, of which four were missed; 50 per cent had neurological deficits, and the majority of these cases had burst fractures and fracture-dislocations. Treatment was non-operative in the majority of cases, with only four cases undergoing anterior spinal decompression and fusion, and one had posterior instrumentation and fusion. At follow-up (1–3 years), only one patient, a child, had significant deformity. All patients with partial neurological deficit improved, whereas none of those with complete neurological lesions recovered. Five patients had significant back pain requiring analgesics but not significant enough to interfere with their activities. We concluded that most of these injuries are stable and should be treated non-operatively. Surgery is only indicated in cases with partial neurological deficit and significant spinal canal compromise or significant instability. Children should be followed up until maturity to look for late deformity.

Nonoperative treatment in burst fractures of the lumbar spine (L2-L5) without neurologic deficits.

A retrospective review of 20 patients treated nonoperatively for burst fractures of the lumbar spine (L2-L5) was performed. All patients were neurologically intact at the time of injury. Follow-up averaged 3.9 years with a range of 2.1 to 9.1 years. Fourteen patients were men and six were women. The average age at injury was 35.8 years (8-67 years). Sixty-five percent of the injuries were the result of motor vehicle accidents and 35% falls from height. Fifty-five percent were two-column injuries and 45% three-column injuries. Kyphotic deformity averaged 8 at injury (-7 to 30) and 9.6 at follow-up (-8 to 33). Computed tomography scans were performed in nine patients during evaluation of injury. Spinal canal compromise averaged 40% (18-75%). Eighteen patients (90%) were considered to have a good to excellent functional outcome, whereas two patients had a fair outcome. No patient had a poor outcome. In no patient did neurologic deterioration or symptomatic spinal stenosis develop. Twenty-five percent of patients had no back pain, 70% mild back pain, and 5% moderate back pain. No patient was totally incapacitated by pain. Of those employed, all returned to full-time work. Nonoperative treatment should be considered as an alternative in the treatment of lumbar burst fractures (L2-L5) in patients presenting without initial neurologic deficits.

Unstable Thoracolumbar and Lumbar Burst Fractures Treated with the AO Fixateur Interne

Twenty-five consecutive patients with unstable thoracolumbar and lumbar burst fractures were surgically treated with the AO Fixateur Interne (Synthes USA, 1690 Russell Rd., Paoli, PA). Indications for surgery included a progressive neurologic deficit, spinal canal compromise greater than 50%, vertebral body collapse greater than 50%, or sagittal angulation greater than 20 degrees. Twenty males and five females ranging in age from 16 to 60 years (average 31) were treated surgically and prospectively followed. Twenty-one fractures occurred at the thoracolumbar junction (T10-L2) and 4 in the lumbar spine (L3-5). Twenty-four patients were followed for a minimum of 12 months, ranging from 12 to 38 months (average 22); one patient was lost to follow-up after 1 month postoperatively. Preoperatively, 12 patients had partial neurologic deficits; postoperatively, 11 improved at least 1 Frankel grade. Preoperatively, the 12 patients with partial neurologic deficits averaged 45 points (range 24-49) on the lower extremity motor index scale. After surgery, these patients improved an average of five points (range 1-23) on the motor index scale. Both patients with complete spinal cord injuries remained unchanged neurologically postoperatively; no patients deteriorated neurologically after surgery. The average preoperative sagittal kyphosis at the fracture site was +16 degrees (range +10 degrees to +31 degrees); the immediate postoperative sagittal angular correction averaged -4 degrees (lordosis) and ranged from +12 degrees (kyphosis) to -26 degrees (lordosis). At last follow-up, the sagittal angular correction remained unchanged in three patients and decreased in 21 patients to an average of +5 degrees (range +37 degrees to -14 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne.

Twenty-five consecutive patients with unstable thoracolumbar and lumbar burst fractures were surgically treated with the AO Fixateur Interne (Synthes USA, 1690 Russell Rd., Paoli, PA). Indications for surgery included a progressive neurologic deficit, spinal canal compromise greater than 50%, vertebral body collapse greater than 50%, or sagittal angulation greater than 20 degrees. Twenty males and five females ranging in age from 16 to 60 years (average 31) were treated surgically and prospectively followed. Twenty-one fractures occurred at the thoracolumbar junction (T10-L2) and 4 in the lumbar spine (L3-5). Twenty-four patients were followed for a minimum of 12 months, ranging from 12 to 38 months (average 22); one patient was lost to follow-up after 1 month postoperatively. Preoperatively, 12 patients had partial neurologic deficits; postoperatively, 11 improved at least 1 Frankel grade. Preoperatively, the 12 patients with partial neurologic deficits averaged 45 points (range 24-49) on the lower extremity motor index scale. After surgery, these patients improved an average of five points (range 1-23) on the motor index scale. Both patients with complete spinal cord injuries remained unchanged neurologically postoperatively; no patients deteriorated neurologically after surgery. The average preoperative sagittal kyphosis at the fracture site was +16 degrees (range +10 degrees to +31 degrees); the immediate postoperative sagittal angular correction averaged -4 degrees (lordosis) and ranged from +12 degrees (kyphosis) to -26 degrees (lordosis). At last follow-up, the sagittal angular correction remained unchanged in three patients and decreased in 21 patients to an average of +5 degrees (range +37 degrees to -14 degrees).(ABSTRACT TRUNCATED AT 250 WORDS)

Management of Thoracolumbar Fractures with Accompanying Neurological Injury

The optimal surgical approach for spinal canal reconstruction of thoracolumbar fractures is controversial, and the relationship between spinal canal reconstruction and neurological recovery remains unclear. To address these issues, 22 consecutive cases of thoracolumbar fracture with accompanying neurological deficit were reviewed. Neurological status was graded at the time of admission, postoperatively, and at a mean of 15 months postinjury. By using preoperative and postoperative radiographs and computed tomographic scans, the degree of spinal canal compromise was quantified in the sagittal, coronal, and axial planes. All fractures were stabilized by posterior instrumentation and fusion, and in 10 injuries, retropulsed vertebral body fragments were further reduced by posterolateral decompression. Spinal canal dimensions, neurological function, and operative approach were compared by using nonparametric statistical analysis. The greater the initial spinal canal compromise, the more severe the neurological deficit (P = 0.04). With injuries involving L1 and above, this relationship increased (P = 0.003). The extent of spinal canal reconstruction failed to correlate with neurological recovery. Compared with spinal instrumentation alone, transpedicular decompression showed no benefit in terms of postoperative canal dimensions or neurological outcome. On the basis of this experience, transpedicular decompression offers no advantage over spinal instrumentation alone. The relationship between initial spinal canal encroachment and neurological deficit demonstrates that the degrees of bony and neurological injury directly reflect the kinetic energy transferred at the time of impact. The lack of correlation between the extent of spinal canal reconstruction and neurological recovery suggests that ongoing neural compression/distortion contributes little to the overall neurological injury.