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Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic spinal cord injury

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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.

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Funding

This study was supported by the Fonds de recherche du Québec—Santé (FRQS), Department of the Army—United States Army Medical Research Acquisition Activity, Medtronic research chair in spinal trauma at Université de Montréal, and Rick Hansen Spinal Cord Injury Registry.

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Authors and Affiliations

  1. Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada

    Julien Goulet, Andréane Richard-Denis, Yvan Petit & Lucien Diotalevi

  2. Faculty of Medicine, Université de Montréal, Montréal, QC, Canada

    Julien Goulet, Andréane Richard-Denis & Jean-Marc Mac-Thiong

  3. Department of Mechanical Engineering, École de Technologie Supérieure (ETS), Montréal, Qc, Canada

    Yvan Petit

Authors
  1. Julien Goulet
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  2. Andréane Richard-Denis
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  3. Yvan Petit
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  4. Lucien Diotalevi
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  5. Jean-Marc Mac-Thiong
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Corresponding author

Correspondence to Jean-Marc Mac-Thiong.

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Conflict of interest

Dr Goulet has received a scholarship from the Medtronic research chair in spinal trauma at Université de Montréal. Andréane Richard-Denis has received a scholarship and research grants from the Fonds de recherche du Québec—Santé, an investigator-initiated research grant from Medline Industries, and a research grant from Praxis Spinal Cord Institute. Dr Petit reports no financial disclosure. Mr Diotalevi has received a salary support from the Medtronic research chair in spinal trauma at Université de Montréal. Dr Mac-Thiong is chairholder of Medtronic research chair in spinal trauma at Université de Montréal, owns stocks and is a board member in Spinologics, and has received a scholarship and research grants from the Fonds de recherche du Québec—Santé, an investigator-initiated research grant from Medline Industries, educational grants from Medtronic and Depuy-Synthes, as well as research grants from the U.S. Department of Defense—Congressionally directed medical research programs, Craig H. Neilsen Foundation, from Social Sciences and Humanities Research Council, Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council, Praxis Spinal Cord Institute, and Vertex Pharmaceutical.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional ethical research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Goulet, J., Richard-Denis, A., Petit, Y. et al. Morphological features of thoracolumbar burst fractures associated with neurological outcome in thoracolumbar traumatic spinal cord injury. Eur Spine J 29, 2505–2512 (2020). https://doi.org/10.1007/s00586-020-06420-9

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  • DOI: https://doi.org/10.1007/s00586-020-06420-9

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