1
|
Schouten R, Keynan O, Lee RS, Street JT, Boyd MC, Paquette SJ, Kwon BK, Dvorak MF, Fisher CG. Health-related quality-of-life outcomes after thoracic (T1-T10) fractures. Spine J 2014; 14:1635-42. [PMID: 24373680 DOI: 10.1016/j.spinee.2013.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 09/13/2013] [Accepted: 09/27/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The thoracic spine exhibits a unique response to trauma as the result of recognized anatomical and biomechanical differences. Despite this response, clinical studies often group thoracic fractures (T1-T10) with more caudal thoracolumbar injuries. Subsequently, there is a paucity of literature on the functional outcomes of this distinct group of injuries. PURPOSE To describe and identify predictors of health-related quality-of-life outcomes and re-employment status in patients with thoracic fractures who present to a spine injury tertiary referral center. STUDY DESIGN An ambispective cohort study with cross-sectional outcome assessment. PATIENT SAMPLE A prospectively collected fully relational spine database was searched to identify all adult (>16 years) patients treated with traumatic thoracic (T1-T10) fractures with and without neurologic deficits, treated between 1995 and 2008. OUTCOME MEASURES The Short-Form-36, Oswestry Disability Index, and Prolo Economic Scale outcome instruments were completed at a minimum follow-up of 12 months. Preoperative and minimum 1-year postinjury X-rays were evaluated. METHOD Univariate and multivariate regression analysis was used to identify predictors of outcomes from a range of demographic, injury, treatment, and radiographic variables. RESULTS One hundred twenty-six patients, age 36±15 years (mean±SD), with 135 fractures were assessed at a mean follow-up of 6 years (range 1-15.5 years). Traffic accidents (45%) and translational injuries (54%) were the most common mechanism and dominant fracture pattern, respectively. Neurologic deficits were frequent-53% had complete (American Spinal Injury Association impairment scale [AIS] A) spinal cord deficits on admission. Operative management was performed in 78%. Patients who sustain thoracic fractures, but escaped significant neurologic injury (AIS D or E on admission) had SF-36 scores that did not differ significantly from population norms at a mean follow-up of 6 years. Eighty-eight percent of this cohort was re-employed. Interestingly, Oswestry Disability Index scores remained inferior to healthy subjects. In contrast, SF-36 scores in those with more profound neurologic deficits at presentation (AIS A, B, or C) remained inferior to normative data. Fifty-seven percent were re-employed, 25% in their previous job type. Using multiple regression analysis, we found that comorbidity status (measured by the Charlson Comorbidity index) was the only independent predictor of SF-36 scores. Neurologic impairment (AIS) and adverse events were independent predictors of the SF-36 physical functioning subscale. Sagittal alignment and number of fused levels were not independent predictors. CONCLUSIONS At a mean follow-up of 6 years, patients who presented with thoracic fractures and AIS D or E neurologic status recovered a general health status not significantly inferior to population norms. Compared with other neurologic intact spinal injuries, patients with thoracic injuries have a favorable generic health-related quality-of-life prognosis. Inferior outcomes and re-employment prospects were noted in those with more significant neurologic deficits.
Collapse
Affiliation(s)
- Rowan Schouten
- Orthopaedic Department, Christchurch Hospital, Riccarton Ave., PO Box 4710, Christchurch 8140, New Zealand
| | - Ory Keynan
- Department of Orthopaedics, Tel Aviv Sourasky Medical Center, Weizmann 10, Tel Aviv, Israel
| | - Robert S Lee
- Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Room 6196, Vancouver, British Columbia V5Z 1M9, Canada
| | - John T Street
- Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Room 6196, Vancouver, British Columbia V5Z 1M9, Canada
| | - Michael C Boyd
- Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Room 6196, Vancouver, British Columbia V5Z 1M9, Canada
| | - Scott J Paquette
- Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Room 6196, Vancouver, British Columbia V5Z 1M9, Canada
| | - Brian K Kwon
- Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Room 6196, Vancouver, British Columbia V5Z 1M9, Canada
| | - Marcel F Dvorak
- Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Room 6196, Vancouver, British Columbia V5Z 1M9, Canada
| | - Charles G Fisher
- Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Blusson Spinal Cord Center, 818 West 10th Ave., Room 6196, Vancouver, British Columbia V5Z 1M9, Canada.
| |
Collapse
|