Scoliosis Research Society. Multicenter spine fracture study

This study consisted of 1,019 spinal fracture patients followed prospectively for 2 years. Sixty-four physicians from 12 countries participated. The purpose of the study was to determine: 1) the relationship between neurologic deficit and fracture type, level, and spinal canal compromise; 2) the neurologic outcome comparing surgical versus nonsurgical treatment and anterior versus posterior surgery; and 3) the relationship of pain to both kyphotic deformity and to surgical and nonsurgical treatment. The main findings of this study are as follows: 1) seat belts reduced the incidence of severe neurologic injury; 2) there was a higher incidence of neurologic deficit with fracture-dislocations and a higher incidence of neurologically intact patients with compression and flexion-distraction injuries; 3) there was a greater incidence of complete neurologic deficits caused by fractures at the spinal cord level, and a diminished incidence at the cauda equina level; 4) for burst fractures there was a weakly positive relationship between canal compromise and neurologic deficit, including bladder function; 5) surgical intervention led to a greater percentage of improved neurologic function than nonoperative treatment, but the rate of improvement was not statistically different; 6) anterior surgery was not more effective than posterior surgery in improving the neurologic function when function was assessed using the Frankel or Motor Index scales, but it was statistically significant when compared to the Manabe scale; 7) in patients who deteriorated before surgery and underwent surgery, there was a greater improvement neurologically, particularly for anterior surgery, compared to those patients treated nonoperatively or to the overall surgically treated group; 8) There was a statistically significant relationship between bladder function and fracture type, with an increased incidence of absent function seen with fracture-dislocations, of impaired function with burst fractures, and of intact bladder function with compression and flexion-distraction injuries; 9) anterior surgery was more beneficial in improving complete bladder impairment to partial impairment compared to posterior surgery; 10) a kyphotic deformity of greater than 30 degrees at 2-year follow-up was associated with an increased incidence of significant back pain; 11) patients who had surgery complained less of severe pain than those who were treated without surgery.