Complication rates in thoracolumbar fracture-dislocations with and without neurological injury

Thoracolumbar fracture-dislocations from high-energy trauma are severe injuries requiring surgical stabilization. The risks faced by neurologically intact patients remain unclear.

To compare early complication rates in surgically treated patients with thoracolumbar fracture-dislocations according to neurological status.

This retrospective multicenter cohort study included patients from 24 institutions in 9 Latin American countries who underwent surgery for thoracolumbar fracture-dislocation between 2015 and 2023. Eligible patients were aged ≥16, of any gender, with high-energy trauma requiring surgery. The primary outcome was early postoperative complications from admission to discharge or death, with patients categorized by neurological injury at admission.

A total of 262 patients were analyzed, primarily young men (n=212; 80.6%) with a mean age of 36.8 years (SD=13.7). The thoracic and thoracolumbar regions were most affected. Only 18% had no neurological damage, and over half with deficits had complete spinal cord injuries. A total of 268 complications were identified (median=1; range 0-9). Postoperative complications occurred in 28.6% of patients without neurological injury and 74.3% with neurological injury (p<0.001). Neurological injury was strongly associated with complications (OR=7.4; 95% CI=3.6-15.4; p<0.001), and clinical instability also had a significant association (OR=3.2; 95% CI=1.6-6.4; p=0.001).

Patients with neurological damage face a markedly higher risk of early postoperative complications after thoracolumbar fracture-dislocation surgery. Results may have limited generalizability due to non-probabilistic institutional sampling.