Timing
Site
ASIA score
preop
AO spine
Sex
F = 45 (27.5 %)
M = 121 (72.5 %)
Median age (years) + SD
Recovery
Early <48h
42 PTS (25.3 %)
T(Thoracic) = 9 (21.4 %)
L(Lumbar) = 26 (61.9 %)
TL(Thoracolumbar) = 7 (16.7 %)
E = 17 (40.5 %)
D = 7 (16.7 %)
C = 0
B = 9 (21.4 %)
A = 9 (21.4 %)
A = 35 (83.3 %)
B = 7 (16.7 %)
C = 0
F = 12 (28.6 %)
M = 30 (71.4 %)
42.3
20.1 ± SD
Median HospitAl stay = 23
Median ICU stay = 17
Complications = 11 %
Intermediate
2–7 days
47 PTS (28.3 %)
T(Thoracic) = 11 (23.4 %)
L(Lumbar) = 24 (51.1 %)
TL(Thoracolumbar) = 12 (25.5 %)
E = 32 (68.1 %)
D = 5 (10.6 %)
C = 3 (6.4 %)
B = 4 (8.5 %)
A = 3 (6.4 %)
A = 44 (93.6 %)
B = 3 (6.4 %)
C = 0
F = 8 (17 %)
M = 39 (83 %)
44.9
±16.1 SD
Median hospital stay. = 29
Median ICU stay = 18
Complications = 21 %
Late
>7 days
46.4 % PTS
T(Thoracic) = 26 (33.8 %)
L(Lumbar) = 34 (44.1 %)
TL(Thoracolumbar) = 17 (22.1 %)
E = 53 (68.8 %)
D = 14 (18.2 %)
C = 4 (5.2 %)
B = 3 (3.9 %)
A = 3 (3.9 %)
A = 70 (90.9 %)
B = 6 (7.8 %)
C = 1 (1.3 %)
F = 25 (32.5 %)
M = 52 (67.5 %)
47.6
±16.9 SD
Median hospitAl stay= 37
Median ICU stay = 26
Complications = 33 %
Table 2
Multivariate analysis: change in neurological status (ASIA score) was related to surgical timing
ASIA score | Site | Timing: early <48h | Intermediate 2–7 days | Late >7 days |
|---|---|---|---|---|
E = 102 PTS | T(Thoracic) = 32 (31.45 %) L(Lumbar) = 50 (49 %) TL(Thoracolumbar) = 20 (19.6 %) | 17 PTS Unchanged = 17 (100 %) | 32 PTS Unchanged = 100 % | 53 PTS Unchanged 100 % |
D = 26 PTS | T = 5 (19.2 %) L = 15 (57.7 %) TL = 6 (23.1 %) | 7 PTS Unchanged = 0 Improved 1grade = 7 (100 %) | 5 PTS Unchanged = 1 (20 %) Improved 1 grade = 4 (80 %) | 14 PTS Unchanged = 3 (21.4 %) Improved 1 grade = 11 (78.6 %) |
C = 7 PTS | T = 2 (28.6 %) L = 4 (57.1 %) TL = 1 (14.3 %) | 0 PTS | 3 PTS Unchanged 1 (33.3 %) Improved 1 grade = 1 (33.3 %) Improved 2 grade = 1 (33.3 %) | 4 PTS Unchanged = 2 (50 %) Improved 1 grade = 1 (25 %) Improved 2 grade = 1 (25 %) |
B = 16 PTS | T = 4 (25 %) L = 6 (37.5 %) TL = 6 (37.5 %) | 9 PTS Unchanged = 1 (11.10 %) Improved 1 grade = 3 (33.3 %) Improved 2grade = 5 (55.6 %) | 4PTS Unchanged = 1 (25 %) Improved 1 grade = 2 (50 %) Improved 2 grade = 1 (25 %) | 3 PTS Unchanged = 2 (66.7 %), Improved 1 grade = 1 (33.3 %) Improved 2 grade = 0 |
A = 15 PTS | T = 3 (20 %) L = 9 (60 %) TL = 3 (20 %) | 9 PTS Unchanged = 9 (100 %) | 3 PTS Unchanged 3 (100 %) | 3 PTS Unchanged = 3 (100 %) |
ASIA E: One hundred and two patients had an ASIA E score: in 32 patients (31.4 %) the fracture was thoracic, in 50 patients (49 %) it was lumbar, and in 20 patients (19.6 %), it was located at the thoracolumbar junction. Seventeen patients underwent early surgery; 32 patients underwent surgery with an intermediate timing, and 53 patients underwent late surgery. The ASIA score was unchanged in relation to the timing of surgery.
ASIA D: Twenty-six patients had an ASIA D score: in 5 patients (19.2 %) the fracture was thoracic, in 15 patients (57.7 %) it was lumbar, and in 6 patients (23.1 %) it was located at the thoracolumbar junction. Seven patients underwent early surgery, with an improvement of one grade in the ASIA score in 100 % of these patients. Five patients underwent surgery with an intermediate timing: in 1 patient (20%) the ASIA score was unchanged, and in 4 patients (80 %) the score was improved by one grade. Fourteen patients underwent late surgery: in three 3 patients (21.4 %) the ASIA score was unchanged and in 11 patients (78.6 %) it was improved by one grade.
ASIA C: Seven patients had an ASIA C score, with a thoracic fracture in two patients (28.6 %), lumbar fracture in four patients (57.1 %), and fracture at the thoracolumbar junction in one patient (14.3 %). None of these patients underwent early surgery. Three patients underwent surgery with an intermediate timing: in one patient (33.3 %) the ASIA score was unchanged, in one patient (33.3 %) the ASIA score was improved by one grade, and in one patient (33.3 %) the ASIA score was improved by two grades. Four patients underwent late surgery: in two patients (50 %) the ASIA score was unchanged, in one patient (25 %) it was improved by one grade, and in one patient (25 %) it was improved by two grades.
ASIA B: Sixteen patients had an ASIA B score; in four patients (25 %) the fracture was thoracic, in six patients (37.5 %) it was lumbar, and in six patients (37.5 %) it was at the thoracolumbar junction. Nine patients underwent early surgery: in one patient (11.10 %) the ASIA score was unchanged, in three patients (33.3 %) it was improved by one grade, and in five patients (55.6 %) it was improved by two grades. Four patients were operated with an intermediate timing: in one patient (25 %) the ASIA score was unchanged, in two patients (50 %) it improved by one grade, and in one patient (25 %) it improved by two grades. Three patients underwent late surgery: in two patients (66,7 %) the ASIA score was unchanged, in one patient (33,3 %) it improved by one grade.
ASIA A: Fifteen patients had an ASIA A score, with thoracic fracture in three patients (20 %), lumbar fracture in nine patients (60 %), and fracture at the thoracolumbar junction in three patients (20 %). The ASIA score remained unchanged regardless of the surgical timing.
This analysis suggests that early surgical treatment appears to provide a better neurological recovery with statistical significance and good predictive value. The better the ASIA score on admission, the better the outcome (p value = 0.001009, χ2 = 26.10).
Third Multivariate Analysis: Correlation Between Site of Fracture and Patient Outcome
In the third statistical analysis we examined the relation between site of fracture and patient outcome.
Thoracic Site
In 46 patients (27.7 %), 10 women (21.7 %) and 36 men (78.3 %), with a median age of 41.1 years (SD + −16.8), the fracture was localized in the thoracic spine: 43 patients (93.5 %) had a type A fracture and and 3 patients (6.5 %) had a type B; 32 patients (69.6 %) had an ASIA E score, 5 patients (10.9 %) an ASIA D, 2 patients (4.3 %) an ASIA C, 4 patients an ASIA B (8.7 %), and 3 patients an ASIA A (6.5 %). In 72.70 % of the patients the ASIA score appeared to be unchanged, while in 27.30 % of the patients it was improved by one grade.
Lumbar Site
In 84 patients (50.6 %), 24 women (28.6 %) and 60 men (71.4 %), with median age of 44.5 years (SD+ 17.4), the fracture was localized in the lumbar spine: in 77 patients (91.7 %) there was a type A fracture, in 6 patients (7.1 %) a type B, and in 1 patient (1.2 %) a type C. Fifty patients (60.4 %) had an ASIA E, 15 (17 %) an ASIA D, 4 (4.8 %) an ASIA C, 6 (7.1 %) an ASIA B, and 9 (10.7 %) an ASIA A. In 4 % of the patients the ASIA score appeared to be unchanged; in 72 % of the patients there was an improvement of one grade and in 24 % an improvement of two grades.
ThoracoLumbar Junction
In 36 patients (21.7 %), 11 women (30.6 %) and 25 men (69.4 %), with a median age of 48.5 years (SD + − 18.9) the fracture was located at the thoracolumbar junction: in 29 patients (80.6 %) there was a type A fracture, and in 7 patients the fracture was type B (19.4 %). Twenty patients (55.5 %) had an ASIA E score, 6 (16.7 %) had an ASIA D, 1 (2.8 %) an ASIA C, 6 (16.7 %) an ASIA B, and 3 (8.3 %) an ASIA A. In 15.40 % of the patients the ASIA score appeared to be unchanged; in 76.90 % of the patients the score improved by one grade, and in 7.70 % of the patients the score improved by two grades.
This analysis shows that regardless of the type of fracture and preoperative ASIA score (p value = 0.357033, χ2 = 4.38), fractures located in the thoracic spine had the worst outcome, with results showing good predictive value and statistical significance (Table 3; Fig. 1).
Table 3
Third multivariate analysis: change in neurological status, expressed by the ASIA score, was related to the site of fracture
