Analysis of Factors Related to Neurological Deficit in Thoracolumbar Fractures

  • Chung, Joon-Ho (Department of Neurosurgery, College of Medicine, Inha University) ;
  • Yoon, Seung-Hwan (Department of Neurosurgery, College of Medicine, Inha University) ;
  • Park, Hyung-Chun (Department of Neurosurgery, College of Medicine, Inha University) ;
  • Park, Chong-Oon (Department of Neurosurgery, College of Medicine, Inha University) ;
  • Kim, Eun-Young (Department of Neurosurgery, College of Medicine, Inha University) ;
  • Ha, Yoon (Department of Neurosurgery, College of Medicine, Inha University)
  • 발행 : 2007.01.30

초록

Objective : The purpose of this study is to determine the factors that have effects on the neurological deficit in the patients with thoracolumbar fracture. Methods : Forty-eight patients were included. Cause of injury, type of injury, time interval, combined injury, kyphotic angle, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, transverse diameter, the most narrow transverse diameter, and remained height of vertebra body were concerned as the factors. The patients with American Spinal Injury Association[ASIA] impairment scale grade A to D were considered as having neurology while others with ASIA grade E were considered to be without neurology. The patients with ASIA grade A were classified to paraplegia group and the patients with ASIA grade B to E were not thought to be paraplegia. Statistical analysis for these groups were performed. Results : Spinal canal compromise [P<0.001] have correlation with neurological deficit. The most narrow sagittal diameter was smaller in the group with deficit than that in the group without deficit [P<0.004]. Also, combined injury have correlation with neurology [P=0.028]. Spinal canal compromise [P<0.001], sagittal diameter [P=0.032], the most narrow sagittal diameter [P=0.025], and Denis type [P<0.001] also have correlation with paraplegia. Conclusion : The factors of percentage of spinal canal compromise, the most narrow sagittal diameter, and combined injury are predictive of neurological deficit. The patients with paraplegia may be predicted by the factors such as type of injury, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, and Denis type.

키워드

참고문헌

  1. Bedbrook G : Treatment of thoracolumbar dislocation and fractures with paraplegia. Clin Orthop 112 : 27-43, 1975
  2. Braakman R, Fontijne WP, Zeegers R, Steenbeek JR, Tanghe HL : Neurological deficit in injuries of the thoracic and lumbar spine. Acta Neurochir 111: 11-17, 1991 https://doi.org/10.1007/BF01402507
  3. Dall BE, Stauffer ES : Neurologic injury and recovery patterns in burst fractures at the T12 or L1 motion segment. Clin Orthop 233 : 171-176, 1988
  4. Dayes LA, Boyd W, Peterson D, Ritland S : The fortune of a capacious spinal canal. J Natl. MedAssoc 71 : 985-987,1979
  5. Durward Q, Schweigel J, Harrison P : Management of fractures of the thoracolumbar and lumbar spine. Neurosurgery 8: 555-561, 1981 https://doi.org/10.1227/00006123-198105000-00007
  6. Eismont FJ, Clifford S, Goldberg M, Green B : Cervical sagittal spinal canal size in spine injury. Spine 9 : 663-666, 1984 https://doi.org/10.1097/00007632-198410000-00001
  7. Fonrijne WP, DeKierk LW, Braakman R, Stijnen T, Tanghe HL, Stseenbeek R, et al : CT scan prediction of neurological deficit in thoracolumbar burst fractures. J Bone Joint Surg 74B : 683-685, 1992
  8. Herndon WA, Galloway D: Neurological return versus cross-sectional canal area in incomplete thoracolumbar spinal cord injuries. J Trauma 28 : 680-683, 1988 https://doi.org/10.1097/00005373-198805000-00022
  9. Kang JD, Figgie MP, Bohlman HH : Sagittal measurements of the cervical spine in subaxial fractures and dislocations. J Bone Joint Surg 76A: 1617-1627, 1994
  10. Kim JS, Kim ES, Lee JS, Park YG, Baek SH, Park IS, et al : A Clinical Analysis of the Patients with Thoracolumbar Vertebral Junction Fracture. J Korean Neurosurg Soc 25 : 2038-2043, 1996
  11. Kim NH, Lee HM, Chun IM : Neurologic Injury and Recovery in Patients With Burst Fracture of the Thoracolumbar Spine. Spine 24 : 290-294, 1999 https://doi.org/10.1097/00007632-199902010-00020
  12. Kuklo TR, Polly Jr DW, Owens BD, Zeidman SM, Chang AS, Klemme WR : Measurement of Thoracic and Lumbar Fracture Kyphosis. Spine 26: 61-66, 2001 https://doi.org/10.1097/00007632-200101010-00012
  13. Lemons V, Wagner F, Montesano P: Management of thoracolumbar fractures with accompanying neurological injury. Neurosurgery 30: 667671, 1992 https://doi.org/10.1227/00006123-199205000-00002
  14. Matsuura P, Waters RL, Adkins RH, Rothman S, Gurbani N, Sie I: Comparison of computerized tomography parameters of the cervical spine in normal control subjects and spinal cord patients. J Bone Joint Surg 71A: 183-188, 1989
  15. Meves R, Avanzi O: Correlation Between Neurological Deficit and Spinal Canal Compromise in 198 Patients with Thoracolumbar and Lumbar Fractures. Spine 30 : 787-791, 2005 https://doi.org/10.1097/01.brs.0000157482.80271.12
  16. Mohanry SP, Venkatram N: Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise? Spinal Cord 40: 295-299, 2002 https://doi.org/10.1038/sj.sc.3101283
  17. Mumford J, Weinstein JN, Spratt FK, Goel VK: Thoracolumbar burst fractures. The clinical efficacy and outcome of nonoperative management. Spine 18: 955-970,1993 https://doi.org/10.1097/00007632-199306150-00003
  18. Panjabi MM, Kifune M, Wen L, Arand M, Oxland TR, Lin RM, et al: Dynamic canal encroachment during thoracolumbar burst fractures. J Spinal Disord 8 : 39-48, 1995
  19. Rosenberg N, Lenger R, Weisz I, Stein H: Neurological deficit in a consecutive series of vertebral fracture patients with bony fragments within spinal canal. Spinal Cord 35: 92-95, 1997 https://doi.org/10.1038/sj.sc.3100356
  20. Osebold W, Weinstein S, Sprague B : Thoracolumbar spine fracturesresults of treatment. Spine 6: 13-34, 1981 https://doi.org/10.1097/00007632-198101000-00004
  21. Starr JK, Hanley EN :Junctional burst fractures. Spine 17: 551-557, 1992 https://doi.org/10.1097/00007632-199205000-00012
  22. Vaccaro AR, Nachwalter RS, Klein GR, Sewards JM, Albert TJ, Garfin SR: The Significance of Thoracolumbar Spinal Canal Size in Spinal Cord Injury Patients. Spine 26: 371-376, 2001 https://doi.org/10.1097/00007632-200102150-00013