Kyphotic Deformity and Retropulsion as Predictors of Surgery in Burst Fractures

Introduction: Burst fractures are serious vertebral injuries often requiring surgical intervention. Kyphotic deformity and retropulsion are critical factors in surgical decision-making, but specific thresholds are not well-defined. This study aimed to determine the predictive value of kyphotic deformity and retropulsion for surgical intervention in burst fractures and establish critical thresholds.

Methods: We retrospectively reviewed 177 patients with burst fractures treated from 2018 to 2023 using a statewide institutional database to evaluate factors associated with surgical intervention or medical management in patients. Imaging studies were independently reviewed by board-certified radiologist and spine neurosurgeon to ensure measurement accuracy. Kyphotic angles and retropulsion were measured through CT radiographs to ensure precise accuracy. Receiver operating characteristic (ROC) curve analysis was performed to identify optimal cutoff values that maximize sensitivity and specificity, specifically using the Youden index. Logistic regression calculated odds ratios (ORs) and 95% confidence intervals (CIs) for predictors. Demographics and clinical characteristics were compared using statistical tests, and multivariable logistic regression identified factors associated with surgical management, adjusting for potential confounders.

Results: Of the 177 patients, 92 underwent surgery, and 85 were managed non-surgically. Surgical patients were younger (mean age 44.7 ± 17.3 years) than non-surgical patients (58.8 ± 19.5 years; p < 0.001). ROC analysis determined that a kyphotic angle greater than 14 degrees was the optimal cutoff for predicting surgical intervention (area under the curve [AUC] = 0.78). Patients with kyphotic angles exceeding 14 degrees had significantly increased odds of surgery (OR 4.18; 95% CI: 1.20–14.6; p = 0.025). Retropulsion occupying more than 25% of the spinal canal was also identified as an optimal cutoff (AUC = 0.75) and was significantly associated with surgical intervention (OR 3.75; 95% CI: 1.10–12.8; p = 0.035). Percentage height loss was not a significant predictor (p = 0.183).

Conclusion : Kyphotic deformity exceeding 14 degrees and retropulsion occupying more than 25% of the spinal canal are significant predictors of surgical intervention in burst fractures. These critical thresholds were established through ROC curve analysis, enhancing clinical decision-making by providing objective criteria. Incorporating these parameters into assessment protocols can improve patient outcomes by guiding timely and appropriate surgical interventions.