Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital.

Study Design: Thirty-five patients with spinal fractures in a series of 1019 patients deteriorated neurologically while in the hospital. Thirty-two were available for review.

Objectives: To determine whether there was a preponderance of a fracture type associated with early neurologic deterioration.

Methods: Patients were evaluated by means of plain radiographs and computed tomography scans according to the classification of Denis for the fracture types. This was compared with a newer classification. Neurologic assessment was according to the Frankel grading system and the motor score index.

Results: Ten patients deteriorated by one Frankel grade and two deteriorated by three Frankel grades; the remaining deteriorated, but within the same grade. The motor score index dropped from 33.5 to 26.8. In the Denis classification, the most common injury was a burst fracture, including a significant number of rotational bursts. In the newer classification, those fractures that contained a component of rotation were the most commonly seen.

Conclusion: When a torsional mechanism has been identified, additional care should be taken in managing patients with spinal fractures because of the risk of further neurologic injury.