Clinical characteristics, fracture patterns, and neurological outcomes in spinal cord injury patients: A prospective cohort study from a high-volume trauma centre

Spinal fractures are a major cause of disability, with outcomes influenced by fracture type, neurological status, and treatment approach. Identifying predictors of neurological improvement is essential for optimizing patient management. To assess the association between fracture type and clinical outcomes and to determine factors linked to neurological improvement in patients with spinal trauma. This prospective cohort study included adults (≥18 years) of either gender with traumatic spinal injuries resulting from road traffic accidents (RTAs), diving, or falls, admitted to a tertiary trauma center. Outcomes included neurological status assessed by the American Spinal Injury Association (ASIA) Impairment Scale at admission, discharge, and three-month follow-up; ambulatory status; pain via visual analogue scale (VAS); and neurological improvement (change in ASIA grade). Data on fracture type, mechanism of injury, treatment modality, physiotherapy, and in-hospital complications were recorded. Associations were analyzed using chi-square tests, with P < .05 considered significant. RTAs were the most common mechanism (49.6%). The mean age was 32.2 ± 11.4 years, and 65.9% were male. Fracture type was significantly associated with ambulatory status (P < .001; 96.8% ambulatory for wedge vs 41.4% for burst fractures), follow-up ASIA grade (P < .001), VAS score (P = .001), and treatment modality (P < .001). Wedge fractures and spinal cord injury without radiologic abnormality (SCIWORA) were linked to better outcomes, whereas burst fractures showed higher neurological deficits (93.5% normal for wedge vs 12.9% for burst). In the follow-up subgroup, neurological improvement correlated significantly with fracture type (P < .001), treatment modality (P < .001), initial ASIA grade (P < .001; OR 15.2 for grade D vs A), physiotherapy (P = .047), follow-up VAS score (P = .006), and complications (P = .047). Greater recovery occurred in patients managed conservatively and those with initial ASIA grades C and D. Fracture type, treatment approach, and rehabilitation significantly influence neurological outcomes in spinal trauma. Wedge fractures and SCIWORA demonstrated favorable prognoses, while early physiotherapy and conservative management promoted recovery. These findings can guide clinicians in treatment selection, counseling, and rehabilitation to enhance neurological and functional outcomes.