Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic
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ORIGINAL ARTICLE
Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic spinal cord injury Julien Goulet1,2 · Andréane Richard‑Denis1,2 · Yvan Petit1,3 · Lucien Diotalevi1 · Jean‑Marc Mac‑Thiong2 Received: 5 November 2019 / Revised: 15 March 2020 / Accepted: 11 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To identify specific morphological characteristics in thoracolumbar burst fractures associated with neurological outcome after severe traumatic spinal cord injury (TSCI). Methods We retrospectively analyzed the clinical and radiological (CT scan morphological characteristics) data of 25 consecutive patients admitted for TSCI secondary to a burst fracture at levels from T11 to L2 between 2010 and 2017 in single level-1 trauma center. We included severe TSCI, defined as American Spinal Injury Association Impairment Scale (AIS) grade A, B or C. Results Among the 25 patients with severe TSCI, 14 were AIS A, 5 were AIS B, and 6 were AIS C upon initial preoperative neurological evaluation. The AIS grade and the burden of associated injuries (Injury Severity Score, ISS) were the only clinical factors significantly associated with poor neurological recovery. The trauma level of energy was not associated with neurological outcome. Several fractures parameters were independently related to neurological recovery: the postero-inferior corner translation, presence of retropulsed fragment comminution and complete lamina fracture. The magnitude of sagittal kyphosis angle, vertebral kyphosis index and vertebral body comminution were not associated with the neurological outcome. Conclusions Morphological features of the bony structures involving the spinal canal in thoracolumbar burst fractures with severe TSCI are associated with the chronic neurological outcome and could provide more insight than the AIS clinical grading. The fracture pattern may better reflect the actual level of energy transferred to the spinal cord than distinguishing between low- and high-energy trauma. Keywords Burst fracture · Thoracolumbar trauma · Neurological outcome · Spinal cord injury
Introduction A better understanding of predictors of neurological recovery in traumatic spinal cord injury (TSCI) enables clinicians to deliver accurate information to patients and families, justify treatment decisions to administrators, optimize resources utilization and create specific rehabilitation programs according to the expected outcome [1]. * Jean‑Marc Mac‑Thiong jean‑marc.mac‑[email protected] 1
Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
2
Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
3
Department of Mechanical Engineering, École de Technologie Supérieure (ETS), Montréal, Qc, Canada
The baseline neurological status is recognized as the single most important clinical predictor of neurological recovery [2, 3]. After clinical evaluation, surgeons will often scrutinize computed tomography scan (CT
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