High Preoperative Canal Compromise as Risk Factor for Worse Neurological Outcome in Patients with Thoracolumbar Burst Fracture After Spinal Decompression and Stabilization Surgery

Abstract

Introduction: Canal compromise (CC) has been associated with neurological outcomes in thoracolumbar burst fractures, with some suggestions indicating a direct correlation with a relatively worse prognosis even after surgical intervention. This study attempted to reveal the association between the preoperative CC in thoracolumbar burst fracture undergoing posterior spinal decompression – stabilization – fusion, with postoperative neurological outcome. Methods: This study adopts a retrospective design, utilizing the medical and radiological records of total of 50 patients (41 males and nine females), with an average age of 42.4 ± 13.57 years. It divided into a case group (comprising 25 patients without neurological improvement) and a control group (consisting of 25 patients with neurological improvement). Consecutive sampling was applied to individuals meeting the predefined inclusion and exclusion criteria. Canal compromise (CC) and the initial neurological function of all participants were assessed in the preoperative period, with a subsequent evaluation of the final neurological function conducted at a minimum of six months postoperatively. Statistical analysis involved descriptive analysis and the Chi-Square test, with the cut-off point determined through Receiver Operating Characteristic (ROC) analysis. Results: The Receiver Operating Characteristic (ROC) analysis identified 40% as the cut-off point distinguishing between low and high canal compromise (CC). Univariate Chi-Square test analysis revealed a statistically significant difference in CC as a risk factor for postoperative neurological deficit. CC exceeding 40% is significantly associated with a relatively worse postoperative neurological outcome (p < 0.001; odds ratio [OR] 21). Conclusion: A high preoperative canal compromise (CC) emerges as a direct risk factor for the absence of neurological improvement in patients with thoracolumbar burst fractures, indicating that higher CC is significantly associated with a relatively poorer prognosis. Keywords: thoracolumbar burst fracture, canal compromise, neurological deficit