Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital.
METHODS
Thirty-five patients with spinal fractures in a series of 1019 patients deteriorated neurologically while in the hospital. Thirty-two were available for review.


OBJECTIVE
To determine whether there was a preponderance of a fracture type associated with early neurologic deterioration.


METHODS
Patients were evaluated by means of plain radiographs and computed tomography scans according to the classification of Denis for the fracture types. This was compared with a newer classification. Neurologic assessment was according to the Frankel grading system and the motor score index.


RESULTS
Ten patients deteriorated by one Frankel grade and two deteriorated by three Frankel grades; the remaining deteriorated, but within the same grade. The motor score index dropped from 33.5 to 26.8. In the Denis classification, the most common injury was a burst fracture, including a significant number of rotational bursts. In the newer classification, those fractures that contained a component of rotation were the most commonly seen.


CONCLUSIONS
When a torsional mechanism has been identified, additional care should be taken in managing patients with spinal fractures because of the risk of further neurologic injury.
Gertzbein
S D
SD
Texas Back Institute, Houston.
D006760:Hospitalization; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D009460:Neurologic Examination; D011859:Radiography; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology*; D016103:Spinal Fractures / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D013904:Thoracic Vertebrae / Q000293:injuries*