Session IX - Pediatrics and Spine

Neurologic Outcome of Operatively Treated Flexion Distraction Spine Injuries

Clifford B. Jones, MD¹; Carlo Bellabarba, MD³; Julie Agel, ATC²; Jens R. Chapman, MD³;

¹Michigan State University, Spectrum Health Medical Center, Grand Rapids, Michigan, USA;

²University of Minnesota, Minneapolis, Minnesota, USA;

³Harborview Medical Center, University of Washington, Seattle, Washington, USA

Purpose: We evaluated neurologic injuries and outcomes of operatively stabilized flexion distraction spine injuries.

Method: A retrospective review was conducted of 115 consecutive patients with T-L, F-D spinal injuries treated at a level I trauma center between 1989 and 1997. The data were obtained from the Trauma Data Registry after appropriate clearance from the hospital's Human Subjects Review Committee. The review included all medical records, radiographs, and clinical follow-up.

Results: Final Frankel grade was available for 97 patients with a diagnosis of flexion distraction injury affecting the thoracic or lumbar spine who were treated with operative stabilization. The average age of the patients was 26.9 years (range, 5 to 66). All patients were involved in transportation accidents: 1 all-terrain vehicle, 1 helicopter, 2 motorcycle, and 93 motor vehicle accidents. The F-D injury occurred most commonly (42%) at the T-L junction (T11 through L1). Of the total, 57 patients were decompressed, reduced, stabilized, and fused within 24 hours, and 22 more patients were treated by day 3. The average length of hospitalization was 12.7 days. Spinal cord injuries occurred in 37 patients (38%); their Frankel grade distribution was A, 19; B, 9; C, 3; and D, 6. At the time of final Frankel grading, all but two of the As were still A except one who improved to E and one who improved to C. Of the nine Bs, one remained a B, four improved to C, one improved to D, and three improved to E. Of the three Cs, one remained a C, and the other two improved to E. Of the six Ds, one remained a D, and the remaining five improved to E. At an average follow-up of 1.8 years, 79 patients had no change in their Frankel grade, 9 improved by one grade, 4 improved by two grades, 3 improved by three grades, 1 improved by four grades, and 1 worsened by one grade (E to D).

Conclusion: Spinal cord injuries frequently occur (38%) with flexion distraction spine injuries. Emergent treatment and stabilization resulted in improvement by at least one Frankel grade in 46% (17 of 37) of all patients who had spinal cord injury and 83% (15 of 18) of patients with incomplete spinal cord injury. Unrestrained drivers in a roll-over motor vehicle accident had the most frequent chance of developing a spinal cord injury.

Significance: In patients receiving early operative decompression and stabilization of associatedflexion distraction spine injuries, onecanexpectneurologic improvement in the majority of patients with incomplete spinal cord injury. Unrestrained front-seat drivers in roll-over motor vehicle accidents are most prone to sustain neurologic injuries.