Incidence of vertebral pedicle fracture occurrence in thoracic and lumbar spine trauma. A CT-scan anatomical assessment - 20/05/26

Doi : 10.1016/j.neuchi.2026.101833

David Gadoin ^a,^b,⁎ , Michel Dagher ^a,^b , Charles Henri Flouzat Lachaniette ^a,^b , Charlie Bouthors ^c , Byoung-Chol Yoon ^a,^b , Arnaud Dubory ^a,^b

^a Department of Orthopaedic Surgery, Hôpital Henri Mondor, AP-HP, Université Paris Est Créteil (UPEC), 94010, Creteil, France

^b Cell and tissue engineering for musculoskeletal disorders (Group 5) / Biology of the NeuroMuscular System (INSERM Team 10) / Institut Mondor de Recherche Biomédicale, U955 INSERM-UPEC, Créteil, France

^c Orthopaedic Department, Tumor and Spine Unit; Bicêtre University Hospital, AP-HP Paris, F-94270; JE 2494 Univ Paris-Sud Orsay, F-01405

^⁎ Corresponding author.

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Highlights

•	Vertebral pedicle (VP) is an essential anatomical structure bringing the vertebral body to the posterior vertebral elements.
•	Pedicle screws posterior instrumentation is the most widespread spinal fixation methods but inevitably needing VP integrity.
•	At the best to our knowledge, no thoracolumbar spinal injury classification has directly considered the occurrence of VP injury expected the AO spine thoracolumbar injury classification in B1 sub-type named transosseous bad disruption Chance fracture comporting an axial VP fracture. A precise VP fracture is absent in all published classifications.
•	VP fracture occurrence in thoracolumbar injury is not anecdotic regarding its founded incidence (25,4%). The increasing incidence of VP fractures is significantly related to the severity of the spine injury like severe neurological spinal injury (ASIA B; p < 0.05), Magerl B2 fractures (p < 0.001), Magerl C1-C2 fractures (p < 0.05) and an important fracture comminution (p < 0.05).
•	VP fractures can be dichotomized into distinct scenarios: bilateral axial VP fractures occurring in a younger population having suffered from a flexion-distraction injury and unilateral frontal VP fractures in an older population in a context of compressive and comminuted spinal fracture.

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Abstract

Study design

Retrospective cohort study

Objective

To determine the incidence and risk factors of VP fractures in thoracic and lumbar spine injuries.

Methods

287 patients were included, and clinical data were collected. From the CT-scans, the presence of VP fracture, Magerl classification, fracture comminution, anatomy of the VP, level of spinal injury, type of VP fracture were assessed. The incidence of VP fractures and their associated risk factors were determined via a Spearman correlation study.

Results

Seventy-three patients (25.4%) with a mean age of 50-years-old (95% CI [30.0 – 70.1]) presented a VP fracture and most (51 patients (69.9%)) had no neurological deficit. VP fractures were unilateral in 57 patients (78.1%) and bilateral in 16 patients (21.9%). Axial VP fractures were linked to Magerl B2 fractures (p < 0.05) while coronal VP fractures were associated with an extensive vertebral fracture comminution (p < 0.05). The incidence of VP fractures increased with severe neurological spinal injury (ASIA B; p < 0.05), Magerl B2 fractures (p < 0.001), Magerl C1-C2 fractures (p < 0.05) and an important fracture comminution (p < 0.05). Communited Magerl A3 fractures were associated with unipedicular fracture, whereas Magerl B2 fractures were linked to bipedicular fractures (p < 0.05). With regard to the type of VP fracture, axial pedicle fractures are found more often in cases of bilateral pedicular fractures (p < 0001). Morphometric data, anatomical characteristics of the VP and the type of trauma did not influence the VP fracture occurrence.