Predicting neurological recovery after thoracolumbar spine trauma: The role of injury morphology and admission American Spinal Injury Association Impairment Scale grade.

Abstract

Objective: The objective of this study was to evaluate the association between fracture morphology, admission American Spinal Injury Association Impairment Scale (AIS) grade, and early neurological outcome in a surgically treated cohort of thoracic and thoracolumbar spine injuries.

Materials and methods: We conducted a retrospective review of 50 consecutive patients who underwent surgery for thoracic or thoracolumbar spine injury at a single tertiary center. Injury morphology was abstracted from operative and radiological records and classified, according to the AOSpine framework, as compression/burst-type injury (type A) or translational injury (type C); a small number of chronic injuries were analyzed separately. Neurological status was assessed using the AIS at admission and discharge. AIS grades were coded ordinally from A = 1 to E = 5, and neurological recovery was defined as the change in AIS grade between admission and discharge. Associations were evaluated using Spearman's correlation, the Wilcoxon signed-rank test, the Kruskal-Wallis test, and Fisher's exact test, with statistical significance set at a two-sided α of 0.05.

Results: The mean age was 36.3 ± 14.0 years (70% of males); the thoracolumbar junction (T11-L2) was involved in 37 (74%) patients. Burst-type injuries predominated (43/50, 86%); 5 (10%) patients had translational injuries. All five translational injuries presented as complete (AIS A) and none improved, whereas burst-type injuries spanned the full AIS range and improved in 19/43 (44%). Overall, 20/50 patients (40%) improved by ≥1 grade, and none deteriorated. Recovery was strongly determined by admission completeness (incomplete [B-D] 75% vs. complete [A] 38% vs. intact [E] 0%; Kruskal-Wallis P < 0.001), and admission grade was very strongly correlated with discharge grade (Spearman ρ =0.93, P < 0.001). The translation-versus-burst difference in recovery did not reach significance given the small number of translational injuries (Fisher P = 0.14).

Conclusions: In this surgically treated cohort, injury morphology appeared to reflect initial neurological severity rather than independently predict early recovery. Translational injuries were uniformly complete and showed no improvement, whereas burst-type injuries were heterogeneous and more frequently recovered. Admission AIS grade and injury completeness were the principal determinants of outcome, and no postoperative neurological deterioration was observed. Prospective studies with formal AOSpine subtyping and longer follow-up are warranted.