Abstract
Between 1990 and 1998, twenty-nine patients with neurological deficits after acute unstable fracture of thoraco-lumbar spine were treatment by surgery at National Taiwan University Hospital. An attempt was made to contact all patients but 4 patients were unavailable for evaluation. The remaining 25 patients were followed for an average of 47.9 months (range 24 to 108 months). Postoperative improvement was observed in 56% and 60% of patients in Frankel grade and muscle power respectively. No patient had any neurological deterioration after surgery. None of these patients with initial Frankel grade A and B regained their ambulatory ability. However, 15 patients (60%) with initial Frankel grade C and D became independent ambulators after surgery (P = 0.0046). None of these patients with initial grade 0 muscle power regained his ambulation ability but all 15 patients (60%) with initial grade 1 to 4 muscle power became independent ambulators after surgery (P = 0.113). 10 patients with initial Frankel A or B had an average 0.4 grade of improvement and 25 patients with initial Frankel C or D had an average 0.9 grade of improvement (P = 0.11). However, those 10 patients with initial power 0 had an average 0.2 grade of improvement and the other 25 patients with initial muscle power 1 to 4 had an average 1.5 grades of improvement (P = 0.003). According to this study, we conclude that Frankel grade and muscle power are good predictors for the clinical outcome of surgical treatment for unstable thoraco-lumbar spine fracture. Patients with such injuries should be managed aggressively especially when residual muscle power could be elicited after the period of spinal shock has passed.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
