Journal List > J Korean Soc Spine Surg > v.16(1) > 1035839

Lee, Lee, Sohn, and Kim: The Analysis of Prognostic Factors on Unstable Burst Fracture on the Thoracolumbar Spine

Abstract

Study Design

A retrospective clinical and radiological analysis

Objectives

To determine the relationship between the classifications of unstable burst fractures on the thoracolumbar region, radiologic studies, signal change area on MRA and analysis of the prognostic factors.

Summary of Literature Review

MRI is the first imaging modality that visualizes the extent of spinal cord derangement directly and it has the potential to provide an accurate diagnosis and prognosis.

Materials and Methods

From March 1998 to September 2006, 39 patients who were eligible for a follow up of more than 1 year with an unstable burst fracture on the thoracolumbar region were studied. With these cases, The size of the bone fragment at the initial injury, signal change area on MRI, time to surgery, reduction rate of the bone fragments, recovery of the posterior curvature of the vertebrae and height of the vertebral body were analyzed.

Results

The mean fracture size rate, average time to surgery, reduction rate of bone fragment and the recovery rate of the height of the vertebral body was 46.1±12.8%, 17±4.5 hours, 35.2±10.1%, and 57.9±17.4%, respectively. The data shows that the time elapsed until surgery had no relationship with the prognosis (P=0.317). Injuries with broad signal changes on MRI were not associated with the reduction rate of bone fragments, recovery of posterior curvature of the vertebrae and the height of the vertebral body.

Conclusions

In unstable burst fractures of the thoracolumbar region, although a comparison of the prognostic factors on simple X-ray film had no significance, it still has significant meaning when correlated with the signals on MRI.

REFERENCES

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Fig. 1.
CT scan shows retropulsed fragment into the spinal canal.
jkss-16-1f1.tif
Fig. 2.
AP and lateral views of preoperative state, kyphotic angle was 24.8 degrees, reserver rate was 24%.
jkss-16-1f2.tif
Fig. 3.
Immediately postoperative state, kyphotic angle was 10.6 degrees, reserver rate was 37%.
jkss-16-1f3.tif
Fig. 4.
Six months after operation, kyphotic angle was 4 degrees, reserver rate was 40%.
jkss-16-1f4.tif
Fig. 5.
Quantitative analysis of signal changes on MRI.
jkss-16-1f5.tif
Table 1.
Age and Sex distribution
  Male Female Total
10~20 3 2 12.8
21~30 3 3 15.4
31~40 5 4 23.1
41~50 2 1 27.7
51~60 3 2 12.8
61~70 4 5 23.1
71~80 1 1 25.1
Total 21 18 100
Table 2.
MR signal area according to PACS system and Neurologic Recovery
MRI signal area Recovery
>100 mm2 0/8(0%)
50~100 mm2 15/24(62.5%)
<50 mm2 7/7(100%)
50~60 mm2 3/4(75%)
60~70 mm2 4/5(80%)
70~80 mm2 5/6(83.3%)
80~90 mm2 2/4(50%)
90~100 mm2 1/5(20%)
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