Correlation Between Neurological Deficit and Spinal Canal Compromise in 198 Patients with Thoracolumbar and Lumbar Fractures

In Brief Study Design. Review the correlation between loss of spinal canal diameter and neurological deficits in patients with thoracolumbar and lumbar burst fractures. Objectives. To try to establish a correlation between neurological deficits and the degree of narrowing of the spinal canal. Summary of Background Data. The correlation between the degree of protrusion of the bone fragments into the spinal canal and the incidence of neurological deficits in thoracolumbar and lumbar burst fractures has not been well established, raising a lot of controversies in the literature. Methods. Manual measurements of axial-computed tomography scan films using a millimetric ruler were made from the spinal canal of 198 patients admitted to the hospital with thoracolumbar and lumbar burst fractures, from 1989 to 2000. Results. The probability of neurological deficit in a patient with 25, 50, and 75% narrowing of the thoracolumbar spinal canal was found to be 12, 41, and 78%, and in the lumbar spinal canal it was 8, 30, and 68%, respectively. Conclusions. The narrowing of the spinal canal proved to be a predictive factor in establishing early neurological deficits in thoracolumbar and lumbar burst fractures, showing a positive correlation between narrowing of the spinal canal and the severity of the incomplete neurological deficit by the Frankel classification. Patients with complete spinal cord injuries (Frankel A) did not show this correlation. Measurements of the spinal canal taken manually with a millimetric ruler from transpedicular cuts of axial-computed tomography films of 198 patients with thoracolumbar and lumbar burst fractures showed that narrowing of the canal caused by the posterior dislocation of the bone fragment is a predictive factor for neurological deficit. A positive correlation between the narrowing of the spinal canal and the severity of the incomplete neurological deficit was observed in this study using the Frankel classification.