Burst fractures in the thoracic and lumbar spine. A clinico-neuropathologic analysis.

Neuropathologic analysis of eight acute and 12 chronic burst fractures was performed. In the acute cases, the injury to the bony, ligamentous, and neural tissues was investigated. Serious Denis B or D fractures showed signs of pronounced instability, and all had a large bone fragment rotated into the spinal canal. The neural tissues were compressed in two cases and transected in one. The Denis A fractures had relatively well-restored ligamentous structures and the bone fragment in the spinal canal was narrowing the spinal canal less than 50% in all cases. Three of four had normal neural tissue macroscopically and microscopically. The majority of the patients with chronic burst fractures did not show any sign of bone fragment resorption. Six out of eight patients with thoracolumbar (T12 and L1) and lumbar (L3) fractures experienced intractable burning pain and/or rhizopathy. The pain seemed to be caused by entrapment of the nerve roots in adhesions.