Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes.

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Abstract

[Indexed for MEDLINE] 9. Neurol Med Chir (Tokyo). 2023 Apr 15;63(4):158-164. doi: 10.2176/jns-nmc.2021-0390. Epub 2023 Mar 1. Evaluation of Posterior Ligamentous Complex Injury in Thoracolumbar Burst Fractures: Correlation Analysis of CT and MRI Findings. Yoshikawa S(1), Nishimura Y(2), Nagashima Y(2), Ito H(2), Oyama T(2), Nishii T(2), Gonda T(2), Ryu H(1), Nomura K(1), Hara M(3), Takayasu M(4), Ginsberg HJ(5), Kanemura T(6), Saito R(2). Author information: (1)Department of Neurosurgery, General Aoyama Hospital. (2)Department of Neurosurgery, Nagoya University Hospital. (3)Department of Neurosurgery, Aichi Medical University Hospital. (4)Department of Neurosurgery, Inazawa Manucipal Hospital. (5)Division of Neurosurgery, St. Michael's Hospital, University of Toronto. (6)Department of Orthopedic Surgery, Konan Kosei Hospital. Erratum in Neurol Med Chir (Tokyo). 2023;63(5):220. doi: 10.2176/jns-nmc.er.2021-0390. The goal of this study is to perform correlation analysis of Computed tomography (CT) and magnetic resonance imaging (MRI) results in posterior ligament complex (PLC) injury and define the morphological traits of thoracolumbar (TL) burst fractures connected to PLC injury. Forty patients with surgically repaired TL burst fractures between January 2013 and December 2020 were retrospectively analyzed. The patients were split into two groups for comparison based on MRI (Group P: patients with a confirmed or suspected PLC injury; Group N: patients with PLC injury denied). The radiographic morphological examination based on CT scans and clinical evaluation was performed and compared between two groups. The thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores, and the number of patients with neurological impairments were considerably greater in Group P. Loss of height of the fracture (loss height), local kyphosis of the fracture (local kyphosis), and supraspinous distance were significantly higher in Group P and significantly associated with PLC injuries indicating severe vertebral body destruction and traumatic kyphosis in multivariate logistic analysis [odds ratio: 1.90, 1.06, and 1.13, respectively]. Cutoff value for local kyphosis obtained from the receiver operating characteristic curve was 18.8. If local kyphosis is greater than 18.8 degrees on CT scans, we should take into account the probability of the highly damaged burst fracture associated with PLC injury. In this situation, we should carefully assess MRI to identify the spinal cord injury or spinal cord compression in addition to PLC injury because these instances likely present with neurological abnormalities. DOI: 10.2176/jns-nmc.2021-0390 PMCID: PMC10166606