Analysis of the risk factors for severity of neurologic status in 216 patients with thoracolumbar and lumbar burst fractures.
METHODS
A retrospective, consecutive case series.


OBJECTIVE
To determine the risk factors that have a significant correlation with the severity of neurologic impairment in thoracolumbar and lumbar burst fractures.


BACKGROUND
The correlation between spinal canal stenosis due to bony fragments and the severity of neurologic deficits in thoracolumbar and lumbar burst fractures remains controversial. Moreover, there have so far been no reports in the literature in which the risk factors (spinal canal stenosis and the disruption of posterior ligamentous complex) causing a severe neurologic deficit were analyzed using a multiple logistic regression model.


METHODS
A review of the clinical data (neurologic impairments on admission and a finding of posterior ligamentous complex disruption at the time of operation), axial computed tomography, and plain lateral radiography of 216 patients in thoracolumbar (T11-L1) and lumbar (L2-L5) burst fractures was performed. The factors related to neurologic impairments were analyzed using a multiple logistic regression model.


RESULTS
In all cases, both the spinal canal stenosis (P < 0.01) and disruption of posterior ligamentous complex (P < 0.01) were significant risk factors. Interestingly, these two risk factors varied according to the injury levels: at thoracic level, the spinal canal stenosis (P < 0.01); at the first lumbar spine, the disruption of the posterior ligamentous complex (P < 0.01); and at the lumbar spine below L2, both of the spinal canal stenosis (P < 0.01) and the disruption of posterior ligamentous complex (P < 0.05) were significant risk factors, respectively.


CONCLUSIONS
In the patients with thoracolumbar and lumbar burst fractures, the significance of the two important risk factors related to clinical results, namely, the stenosis ratio of spinal canal and the disruption of posterior ligamentous complex, were found to vary depending on the level of injury.
Department of Orthopaedic Surgery, Japan Labour Health and Welfare Organization Spinal Injuries Center, Iizuka City, Fukuoka, Japan. iyugue@orange.ocn.ne.jp
Itaru
I
Yugué
Kiyoshi
K
Aono
Keiichiro
K
Shiba
Takayoshi
T
Ueta
Takeshi
T
Maeda
Eiji
E
Mori
Osamu
O
Kawano
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009468:Neuromuscular Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009469:Neuromuscular Junction / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013115:Spinal Canal / Q000293:injuries / Q000473:pathology; D016103:Spinal Fractures / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013124:Spinal Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult