Abstract
Introduction
In all traumatic injury there is a clear relationship between the structural tissue damage and resultant disability after recovery. There are no publications that compare significant thoracolumbar osseous injury to non specific soft tissue injury.
Aim
To compare spinal outcome measures between patients with self reported back pain in the workplace perceived as injury to those having sustained structural injury in the form of an unstable thoracolumbar fracture requiring surgical stabilisation.
Method
Two consecutive cohorts consisting of 23 patients with healed thoracolumbar fractures and 21 patients with a perception of work related injury were compared. Patient outcomes were measured using the Oswestry Disability Index (ODI), Low Back Outcome score (LBOS), Modified Somatic Perception (MSP) and Modified Zung Depression (MZD) indices.
Results
23 patients (8 females; 15 males) with spinal fractures (group 1), of average age 42 years were followed up for a mean of 41 months post trauma and compared to 21 patients (6 females; 15 males) with self reported back pain pursuing compensation claims, (group 2), of average age 47 years, mean time since perceived injury of 42 months. Both groups were comparable in terms of age and sex.
The average ODI in group 1 was 28% (SD 18.5) compared to 52% (SD 17.1) in group 2 (P: 0.0003). Similarly, LBOS was 39.7 Vs 20.3 (P: 0.0003); MSP 4.3 Vs 9.65 (P: 0.03); and MZD 20.2 Vs 35.9 (P: 0.001) in groups 1 and 2 respectively.
Conclusion
Despite high energy trauma and significant structural damage to the spine, post-traumatic patients had better spinal outcome scores in all measures (ODI, LBO, MSP, MZD). There is no ‘dose-response’ relationship to functional outcomes. In fact, the disability seems greater in the lower energy injury which is unique in trauma care.
