Background: There is conflicting evidence of correlation between clinical outcome and severity of thoracolumbar spine fractures in neurologically intact patients1. Kalyan et al2 presented the results of their prospective study of thoracolumbar spinal fractures and concluded that the clinical outcome was consistently better predicted by the severity of disc injury than that of the bony fracture. They suggested that if severe disc injury was present, treatment of the disc injury may result in a better short term clinical outcome. The aim of this study was to detail the incidence and type of disc injury in patients with thoracolumbar spinal fractures with intact neurology.

Methods: Retrospective analysis of a prospectively collected spinal injury database at a regional spinal injuries unit. Only patients with a thoracolumbar spinal fracture and intact neurology were included. Retrospective analysis of magnetic resonance imaging (MRI) findings. One hundred and thirty nine neurologically intact patients (89M:50F, mean age 36 years, range 15 – 77yrs) with a thoracolumbar (T11 –L5) spinal fracture were admitted to our spinal unit over the last 11 years (1994 – 2004). Patient data was collected prospectively onto a spinal injuries database. All of these patients had an MRI scan on admission. All types of thoracolumbar fracture were included in this study and the presence or absence of an associated disc injury was recorded retrospectively from the MRI study. The type of disc injury was also recorded.

Results: The incidence of severe disc injury adjacent to a thoracolumbar spinal fracture in our cohort of patients was 43% (60 patients). Disc prolapse or extradural herniation was seen in 16 patients (11%). Intraosseous disc herniation into an adjacent vertebral body was seen in 20 patients (14%). Internal disc disruption was seen in 24 patients (17%). Disc injury was found at more than one level in 21 patients (15%).

Conclusion: The incidence of severe disc injury in our study of neurologically intact patients with a thoracolumbar fracture was considerable (43%). Kalyan et al² suggested that treatment directed at addressing the disc injury in these patients may promote earlier pain relief and also earlier return to pre-morbid activities. If this is the case, then the decision making regarding operative versus non-operative management, in a patient with a thoracolumbar fracture and intact neurology, should be based on the severity of the disc injury as well as the bony injury.

Study Design: A retrospective case-note study.

Objective: To evaluate causes of delayed admission for patients with spinal injuries.

Subjects: 432 patients admitted between March 1998 and March 2003.

Outcome Measures: Patients were analysed with respect to Injury Severity Score (ISS); date of injury, referral and admission independently and length of hospitalisation. The delays between injury and referral (> 3 days) and between referral and admission (> 7days) were correlated to the length of hospitalisation.

Results: There were 322 males (average age, 38.6 years) and 110 females (average age, 41.8 years), with 108 complete injuries, 115 incomplete and 209 intact. The average time between injury and referral was 5.5 days (range 0–94), and between referral and admission was 10.7 days (range 0–130). 161 patients (37%) experienced a delay between injury and referral, of whom 59 (37%) were subsequently also delayed to admission. The principal reason for delay was the treatment of concurrent injuries. Even patients with complete injuries (15/43) experienced delayed referral. 112 patients (26%) experienced a delay between referral and admission. Principal reasons included the provision of beds and stabilisation of concurrent injuries. We found the delay between referral and admission (p< 0.001), the ISS (p< 0.001) and increasing neurological severity of injury (p< 0.001) to be highly significant factors predisposing to longer hospitalisation.

Conclusions: Delayed admission for patients with spinal injuries is common. Provision of beds being the most common preventable reason for delay following referral. Early liason with a designated spinal injuries unit, especially for patients with cord injury remains vitally important.