Surgical outcomes and correlation ODI and ASIA scores in patients with thoracolumbar and lumbar burst fractures

Background and Purpose: Decision-making process in Thoracolumbar and Lumbar Burst Fracture (TLBF) patients with Thoracolumbar Injury Severity and Classification Score (TLICS) > 4 is remained controversial. On the other hand, the question is whether that the Oswestry Disability Index (ODI) can be use to assess to clinical outcomes in these patients. We aimed to study the correlation between the ODI and American Spinal Injury Association (ASIA) impairment scale in these patients and evaluation of surgical outcome.

Methods: This was a prospective study. The TLICS were determined and TLICS > 4 was included. The nerve injury was assessed according to sensory scores and motors scores of the using ASIA Scale at pre- and postoperative. It was also ODI calculated at last follow-up. In addition, correlation between ASIA and ODI was evaluated at last follow-up.

Results: Fifty eight patients (20.7% female) who underwent spinal surgery for TLBF with a minimum follow up of 2 years were studied. The mean age was 30.7 ± 8.7 (24 to 65) years. Automobile accident was the predominant mode of injury. Patients were followed for 25 months on average (24 – 43 months). ASIA sensory scores and motor scores were improved significantly at last follow-up (P < 0.001). No patient experienced neurological worsening during the follow-up period. The mean ODI were 29.7 (SD= 4.9) at last follow-up. Correlation test showed significant correlations among the ODI and the ASIA sensory scores (r = 0.74, P < 0.02) and motor scores (r = 0.78, P < 0.01) at last follow-up assessment.

Conclusion: The findings confirm that for TLICS > 4 surgical outcome is acceptable. It also shows that the ODI and the ASIA scores have a strong correlation in measuring disability in patients with TLBF after at least 2 year follow-up.