Predictors of postoperative neurological deficits in traumatic thoracolumbar fractures

Alp Karaaslan, Department of Neurosurgery, Sancaktepe Training and Research Hospital, Istanbul, Turkey

Objective: The goal of this retrospective study was to assess the outcomes of vertebral stabilization following acute traumatic thoracolumbar (TL) fractures. Methods: The study examined the mechanism and location of trauma, pre-operative and postoperative neurological deficits, stabilization level, screw malposition, cerebrospinal fluid fistula, development of post-operative infections, additional pathological findings, mobilization times, and follow-up durations. Results: The study included 55 patients. Falls were the leading cause of trauma (75%), and L1 was the most common fracture site (30.9%). A4 was the most common fracture type (61.8%), with T11-L3 being the most frequently stabilized level (32.7%). Screw malposition occurred in 3.6% of cases, and CSF fistula was more common in types B and C. The presence of pre-operative neurodeficits and TL American Orthopedic Spine Injury Score (AOSIS) type B and C significantly increased the risk of post-operative neurological complications. Univariate analysis showed that pre-operative neurodeficits (odds ratio [OR]: 396, 95% confidence intervel [CI]: 22-6935, p < 0.001) and TL AOSIS types B (OR: 11.78, 95% CI: 1.88-73.58, p = 0.008) and C (OR: 9.9, 95% CI: 1.31-74.73, p = 0.026) significantly increased the risk of post-operative neurodeficits. Conclusions: This study, therefore, takes into consideration the strong impact of pre-operative neurological deficit and injury severity with respect to TL classifications on post-operative outcomes for patients undergoing surgical stabilization for traumatic fractures.

Keywords: Traumatic spine fracture. Thoracolumbar fracture. Trauma.