Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital.

Abstract

Thirty-five patients with spinal fractures in a series of 1019 patients deteriorated neurologically while in the hospital. Thirty-two were available for review. To determine whether there was a preponderance of a fracture type associated with early neurologic deterioration. Patients were evaluated by means of plain radiographs and computed tomography scans according to the classification of Denis for the fracture types. This was compared with a newer classification. Neurologic assessment was according to the Frankel grading system and the motor score index. Ten patients deteriorated by one Frankel grade and two deteriorated by three Frankel grades; the remaining deteriorated, but within the same grade. The motor score index dropped from 33.5 to 26.8. In the Denis classification, the most common injury was a burst fracture, including a significant number of rotational bursts. In the newer classification, those fractures that contained a component of rotation were the most commonly seen. When a torsional mechanism has been identified, additional care should be taken in managing patients with spinal fractures because of the risk of further neurologic injury.