Outcome after vertebral fractures with neurological lesion treated either surgically or conservatively in Spain

Out of 245 patients with spinal cord injury admitted to the Hospital Nacional de Paraplejicos of Toledo (110 treated conservatively, 135 treated surgically), randomised samples of 48 cases treated conservatively and 75 treated surgically were selected for comparison. Improved neurological status according to the Frankel scale was achieved in 37.5% after conservative treatment, and in 23% after surgery. Reduction and stabilisation were achieved by both conservative and surgical methods, and the functional outcome was the same for both treatments. The mean hospitalisation time was 198 +/- 10 (mean +/- SE) days for patients treated with conservative measures, and 222 +/- 9 days for patients treated surgically. No correlation was found between the type of fracture and severity of the neurological lesion. The neurological outcome by type of fracture was also similar for both treatments. No correlation was found between the degree of vertebral wedging and neurological evolution. Patients with greater vertebral displacement showed a worse neurological outcome. Taking both groups as a whole, incomplete lesions showed improvement in 66%, and complete in 14%. Neurological improvement after incomplete lesions was found in 87.5% of patients under 25 years of age and in 47% of those over 25 years. The poorest rate of improvement was found in those with thoracic lesions (17%), while those with cervical lesions improved most (48%). Furthermore, the neurological outcome in patients who were surgically treated within the first 24 hours after the injury was not statistically different from those who were treated later.