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Moon, Jeong, Lee, and Jeong: CT Findings Predictive of Neurological Deficits in Thoracolumbar Burst Fractures
Musculoskeletal Radiology
Original Article

Journal of the Korean Society of Radiology 2016; 75(3): 185-190.

Published online: 18 August 2016

DOI: https://doi.org/10.3348/jksr.2016.75.3.185

CT Findings Predictive of Neurological Deficits in Thoracolumbar Burst Fractures

Tae Yong Moon, MD1, Hee Seok Jeong, MD1, In Sook Lee, MD2, Yeo-jin Jeong, MD1

1Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea.

2Department of Radiology, Pusan National University Hospital, Busan, Korea.

Corresponding author: Tae Yong Moon, MD. Department of Radiology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel. 82-55-360-1831, Fax. 82-55-360-1846, tymn@pusan.ac.kr

Received 16 October 2015       Revised 25 December 2015       Accepted 16 April 2016

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the computed tomography (CT) findings predictive of neurological deficits in thoracolumbar spine injuries.

Materials and Methods

One hundred two patients with thoracolumbar spinal burst fractures, after excluding the patients with brain and cervical cord injuries and unconsciousness, who underwent consecutive spine 128-multidetector CT scan formed the study group. The neurological findings were clinically classified as no deficit (n = 58), complete deficit with paraplegia (n = 22), and incomplete deficit with either motor or sensory impairment (n = 22). The following four CT imaging parameters were analyzed: the level of the main burst fracture as the cord (n = 44) and the cauda equina (n = 58) levels; the extent of canal encroachment as central canal ratios (CCRs) below 0.5 (n = 43) and above 0.5 (n = 59); the degree of laminar fracture as no fracture (n = 33), linear fracture (n = 7), separated fracture (n = 27), and displaced fracture (n = 35); fractured vertebra counted as single (n = 53) and multiple (n = 49).

Results

Complete neurological deficit was associated with injuries at the cord level (p = 0.000) and displaced laminar fractures (p = 0.000); incomplete neurological deficit was associated with CCRs below 0.5 (p = 0.000) and multiple vertebral injuries (p = 0.002).

Conclusion

CT scan can provide additional findings predictive of neurological deficits in thoracolumbar spinal burst fractures.

Keywords: Spinal Injuries, Neurological Disorders, Computed Tomography, Thoracic Vertebrae, Lumbar Vertebrae

Figures and Tables

Fig. 1

The value of the central canal ratio is the narrowest diameter of the canal (b) divided by the normal anteroposterior diameter (a) on the axial CT scan.

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Fig. 2

The grades of laminar fractures.

A. A 23-year-old woman with an incomplete neurological deficit. The axial CT scan shows a grade 1 linear laminar fracture of the 2nd lumbar vertebra (arrow).
B. A 48-year-old man with a complete neurological deficit. The axial CT scan shows a grade 2 separated laminar fracture of the 8th thoracic vertebra (arrow).
C. A 45-year-old woman with a complete neurological deficit. The axial CT scan shows a grade 3 displaced laminar fracture of the 11th thoracic vertebra (arrow).
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Fig. 3

A 52-year-old male with an incomplete neurological deficit in multiple vertebral injuries.

A. The sagittal CT scan demonstrates one burst fracture of the 1st lumbar vertebra (thick black arrow) and three compression fractures of the 2nd to the 4th lumbar vertebrae (thin black arrows).
B. The sagittal MR T2 image illustrates one burst fracture of the 1st lumbar vertebra (thick white arrow) and three compression fractures of the 2nd to the 4th lumbar vertebrae (thin white arrows).
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Table 1

Neurological Deficits Related with the Levels of Main Burst Fracture

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Neurological Deficits Cord (Conus Medullaris) Cauda Equina Total
Positive 27 (10) 17 44
 Complete 22 (5) 0 22
 Incomplete 5 (5) 17 22
Negative 17 (12) 41 58
Total 44 (22) 58 102
Table 2

Neurological Deficits Related with the CCRs

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Neurological Deficits CCR ≤ 0.5 CCR > 0.5 Total
Positive 29 15 44
 Complete 12 10 22
 Incomplete 17 05 22
Negative 14 44 58
Total 43 59 102

CCR = central canal ratio

Table 3

Neurological Deficits Related with the Laminar Fractures

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Neurological Deficits Laminar Fractures Total
Displaced* Separated Linear No Fracture
Positive 28 8 2 6 44
 Complete 19* 2 1 0 22
 Incomplete 9 6 1 6 22
Negative 7 19 5 27 58
Total 35 27 7 33 102

*Complete neurological deficit in displaced fracture; sensitivity 77.3%, specificity 66.3%, accuracy 68.6%, and precision 38.6%

Table 4

Neurological Deficits Related with Fractured Vertebra Counts

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Neurological Deficits Single Double Triple Quadruple Total
Positive 16 14 8 6 44
 Complete 11 6 5 0 22
 Incomplete* 5 8 3 6 22
Negative 37 18 2 1 58
Total 53 32 10 7 102

* Incomplete neurological deficits in multiplicity; sensitivity 34.7%, specificity 90.6%, accuracy 63.7%, and precision 77.3%

Acknowledgments

This work was supported for two years by Pusan National University Research Grant.

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