2018, Cilt 10, Sayı 1, Sayfa(lar) 016-023
Functional And Clinical Outcome Of Acute Traumatic Thoracolumbar Spinal Fractures
Aykut Akpınar1, Uzay Erdoğan2, Ali Osman Akdemir1
1Sağlık Bilimleri Üniversitesi Haseki Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye
2Sağlık Bilimleri Üniversitesi Bakırköy Ruh ve Sinir Hastalıkları Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye
Keywords: spinal cord injury, functional/clinical outcome, kyphoplasty, vertebroplasty

Aim: Disruptions of the thoracolumbar spine are often a result of high-energy injuries, the majority caused by motor vehicle accidents and falls. The sequelae of traumatic fractures of thoracolumbar spine injuries may be devastating, including paralysis, pain, deformity, and loss of function. Available therapeutic options for thoracolumbar vertebral fractures include conservative therapy, decompression, posterior reduction and instrumentation, and percutaneous vertebral augmentation procedures (VAP) with vertebroplasty or kyphoplasty. This study aims to see the acute spinal fractures surgical management’s outcomes.

Materials and Methods: Between January 2013 and August 2014, a total of 90 patients (47 males, 43 females; mean age: 53.68±17.96 years; range, 16 to 87 years) who were admitted to hospital with traumatic spinal injury were included. A careful neurological examination of both motor and sensory systems was performed. High-resolution spinal computed tomography (CT) was performed. A total of 43 consecutive patients treated with instrumentation for unstable spinal fractures and 47 patients with compression or burst vertebra fractures treated with VAP were followed. Pain was assessed using the Wong-Baker Face Scale (WFS).

Results: Of all patients, 39 had osteoporosis (T score < -2.5). The injury types were traffic accident (32.2%), falling from a height (60%), and penetrating trauma (7.8%). A total of 24 patients had neurological deficits. Five of them were paraplegic. The mean postoperative pain score decreased and the majority of the patients returned to work earlier. The mean preoperative pain score was 5.51(±0.50), while the mean postoperative pain score was 2.38 (±0.57). After early stabilization, the motor strength scores improved. The mean preoperative motor strength (PREMS) was 3.84(±1.36), while the mean postoperative motor strength (POSTMS) was 4.081(±1.30). After stabilization surgery, one patient died due to pulmonary embolism and one patient had an infection with serosal fluid leakage in the surgical site. No other patients were lost to follow-up. We correlated the pain scores with stabilization group parameters (osteoporosis, number of fractured vertebrae, motor strength). In the osteoporosis group, there was no correlation between pain and the procedure performed. But both preoperative and postoperative motor strength were negatively correlated with pain scores (P < 0.05). The postoperative pain score was higher when the number of fractured vertebrae increased (p < 0.05). Osteoporosis and postoperative motor strength were the independent predictors of postoperative pain.

Conclusion: In this study, both VAP and stabilization procedures reduced the mean pain scores and helped with earlier mobilization. The patients with incomplete spinal cord injuries with progressive deficits requiring decompression and instrumentation were treated as soon as they were medically stable, usually within the earliest time of injury, and this improved the postoperative motor strength.