Critical Canal Diameter Reduction in Burst Fractures: A Marker for Surgical Necessity

Introduction: Burst fractures are severe vertebral injuries resulting from high-energy axial loads, leading to vertebral body fragmentation and displacement in multiple directions. This displacement can cause bone fragments to intrude into the spinal canal, potentially damaging the spinal cord and leading to neurological deficits. Measuring the anteroposterior (AP) canal diameter on radiographic imaging provides crucial information for surgical decision-making. This study aims to quantify the association between reduced AP canal diameter and the likelihood of surgical intervention in patients with burst fractures.

Methods: We conducted a retrospective review of 177 patients with burst fractures treated between 2018 and 2023 using a statewide institutional database. Patients were categorized based on their AP canal diameter, specifically identifying those with a diameter ≤9 mm (n = 50). Demographic and clinical characteristics were compared using Chi-square and Fisher’s exact tests. Multivariable logistic regression analyses were performed to determine factors associated with surgical versus medical management, adjusting for potential confounders. The primary outcome was the need for surgical intervention.

Results: Patients with an AP canal diameter ≤9 mm had significantly increased odds of undergoing surgical intervention (odds ratio [OR] = 11.1; 95% confidence interval [CI]: 3.13–50.0; p < 0.001). Additionally, the residual canal area was significantly smaller in the surgical group compared to the non-surgical group (p < 0.0001), indicating a greater degree of canal compromise among those requiring surgery.

Conclusion : An AP canal diameter of ≤9 mm is a strong predictor of surgical intervention in patients with burst fractures. This threshold provides valuable information for surgeons in making informed decisions regarding the necessity of surgery. Incorporating AP canal diameter measurements into the assessment protocol can enhance clinical decision-making and potentially improve patient outcomes by identifying those at higher risk of spinal cord compromise.