Neurologic recovery from thoracolumbar burst fractures: is it predicted by the amount of initial canal encroachment and kyphotic deformity?
BACKGROUND
The association between neurologic recovery and initial compromise of spinal canal and sagittal alignment has been rarely documented. This study was performed to better understand whether the degree of neurologic recovery from thoracolumbar burst fractures is affected and predicted by initial compromise of spinal canal and sagittal alignment.


METHODS
Eighty-seven patients who underwent conservative or surgical treatment for thoracolumbar burst fractures between 1993 and 2001 were prospectively followed up for 3 to 10 years (average, 5.5 years). They were assessed for neurologic deficit and improvement as defined by the scoring system of ASIA, the stenotic ratio of spinal canal and kyphosis angle.


RESULTS
The ASIA score in 52 patients with neurologic deficit averaged 34.0 (range, 0-50) on admission and 46.1 (range, 27-50) at final follow-up. All these patients except 2 with neurologic deficit experienced improvement with an average recovery rate of 72.7% (range, 0%-100%). No statistically significant difference (P > .05) in the stenotic ratio of spinal canal or kyphotic deformity was demonstrated among the patients with no neurologic deficit, with incomplete lesions, and with complete lesions. The stenotic ratio of spinal canal or kyphosis angle was not significantly correlated with initial and final ASIA score and recovery rate (P > .05).


CONCLUSIONS
The neurologic recovery from thoracolumbar burst fractures is not predicted by the amount of initial canal encroachment and kyphotic deformity. When deciding on the treatment for patients with thoracolumbar burst fractures, both neurologic function and spinal stability should be taken into account.
Dai
Li-Yang
LY
Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. chinaspine@163.com
Wang
Xiang-Yang
XY
Jiang
Lei-Sheng
LS
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D013130:Spinal Stenosis / Q000175:diagnosis / Q000209:etiology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed