Neurologic Injury and Recovery Patterns in the Spinal Fractures by Denis Classification

Kim, Nam Hyun; Park, Moon Soo; Moon, Seong Hwan; Kang, Yong Ho; Sung, Chang Hun; Lee, Hwan Mo

Abstract

PURPOSE: To determine whether there was a preponderance of a fracture type associated with early and late neurologic deterioration.
MATERIALS AND METHODS
The review of all the surgically managed spinal fractures from October 1989 to July 1999 was performed. Of the 83 surgically managed patients, 39 had spinal cord injury. The other 44 patients in this consecutive series had no spinal cord injury. Charts, operative notes, preoperative and postoperative plain radiographs, computed tomography scans, and follow up records of all patients were reviewed carefully from the time of surgery until last follow-up assessment. The classification of Denis had been used prospectively for all patients before their surgery to determine the fracture morphology. Frankel Scale and American Spinal Injury Association Spinal Cord Injury Assessment Form(ASIA) were obtained during follow-up evaluation for all patients.
RESULTS
All patients were observed over mean 57.4 months except 1 patient who died of pulmonary thromboembolism 1 week after surgery. In Denis classification, the most common injuries were burst fracture and fracture-dislocation. The degree of neurologic injury when first seen and at the latest follow up was different between burst fracture and fracture-dislocation. The extent of neurologic recovery was not different between burst fracture and fracture-dislocation. The fracture-dislocation was common in thoracic spine and the degree of neurologic injury was most severe in thoracic spine. Instead, the burst fracture was more common in lumbar spine and the degree of neurologic injury was relatively mild in lumbar spine.
CONCLUSIONS
The severity of initial posttraumatic and the last follow up neurologic injuries were correlated with the fracture patterns by Denis classification, but the extent of neurologic recovery was not correlated with the fracture patterns by Denis classification. The lumbar fracture, injuring the cauda equina and the sacral nerve roots, shows greater recovery patterns than thoracic spine fractures.