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 managements 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.