Thoracolumbar burst fractures: CT dimensions of the spinal canal relative to postsurgical improvement

Cross-sectional spinal canal area was measured before and after surgery in 12 patients with thoracolumbar burst fractures and canal narrowing caused by retropulsed fragments. Patients were classified into Denis type A or type B. Denis type A fractures have comminution of both end-plates of the vertebral body creating multiple smaller fractures; Denis type B fractures have comminution of the superior end-plate only with a single vertical fracture line into the inferior end-plate creating larger fragments. The degree of neurologic impairment was assessed before and after surgery using the Frankel system. There was no correlation between degree of canal narrowing and degree of neurologic impairment. The degree of spinal canal narrowing reflects the final resting position of the vertebral body fragments after trauma; during trauma, greater degrees of canal impingement may have occurred. Also, significant canal narrowing may be present without pinching of the cord or cauda equina. All patients with Denis type A fractures had near-anatomic reduction of fragments out of the spinal canal by surgery; less than half of the patients with Denis type B had good reduction. There was no correlation between reduction of retropulsed fragments and subsequent neurologic improvement. However, this should not preclude surgery as a therapeutic option: Eight of 10 patients with neurologic impairment experienced some improvement in symptoms after surgery; the other two were unchanged.