Correspondence

Spinal Injuries in the Sichuan Earthquake

N Engl J Med 2009; 361:636-637August 6, 2009

Article

To the Editor:

A magnitude 8.0 earthquake hit the densely populated region of Sichuan, China, on May 12, 2008, causing an estimated 374,643 injuries. By July 23, 2008, a total of 2728 wounded patients had been treated at the nearest major university hospital, which had 4300 beds and was located 92 km away from the epicenter, Wenchuan County.

A total of 13.0 to 15.2% of all patients with earthquake-related trauma who were admitted to the hospital had spinal injuries.1,2 Multidetector-row computed tomography (CT) with multiplanar reformation is a fast and reliable method that can be used to determine the pattern and severity of spinal injury and the degree of spinal instability.3 We retrospectively reviewed the multidetector-row CT scans of 223 patients with clinically worrisome spinal injuries after the Sichuan earthquake. Patients injured by earthquake-related motor vehicle accidents were excluded. The study was approved by the ethics committee of the West China School of Medicine, Sichuan University.

We used multidetector-row CT to focus on anatomical locations of the injury, injury types according to the Magerl (AO) classification (Figure 1Figure 1Classifications of the 252 Major Injuries According to the Magerl (AO) Types.),4 and the degree of narrowing of the spinal canal.5 We also relied on clinical symptoms to determine the degree of impairment of neurologic function.

According to clinical records, 185 patients had sustained crush injuries and 38 had fallen; there were a total of 501 vertebral injuries in 198 patients. Among all spinal injuries, we identified 252 major injuries (50.3%) and 249 minor injuries (49.7%). Injuries in the lumbar spine were most common (277 injuries; 55.3% of all injuries), and injuries of the thoracic spine were the next most common (156 injuries; 31.1% of all injuries).

There were 282 injuries at the T12 to L3 levels. The 252 major injuries consisted mainly of Magerl type A injuries (Figure 1) (P<0.001 according to the chi-square test for the comparison with each other type). A total of 43 vertebral injuries of type B (Fig. 1 through 4 in the Supplementary Appendix, available with the full text of this letter at NEJM.org) and 10 injuries of type C2 were associated with type A injuries. Of these 53 associated type A injuries, 39 were type A3. Of the major injuries, we detected narrowing of the spinal canal of 0 degrees (no constriction of the spinal canal) in 110 vertebrae, 1 degree (constriction of one third of the spinal canal) in 76 vertebrae, 2 degrees (constriction of two thirds of the spinal canal) in 50 vertebrae, and 3 degrees (constriction of all of the spinal canal) in 16 vertebrae (Fig. 5 in the Supplementary Appendix). Neurologic deficit occurred in 65 patients (29.1%). Neurologic function according to Frankel's classification was grade A (complete) in 14 patients, grade B (sensory only) in 8 patients, grade C (useless motor power without motor function) in 24 patients, and grade D (useful motor power without functional movement) in 19 patients. The incidence of neurologic deficit increased significantly from Magerl type A through type C: neurologic deficit was associated with 18.7% of type A lesions, 33.3% of type B lesions, and 59.1% of type C lesions (P=0.001 according to the chi-square test for all three comparisons); this was consistent with the finding of Magerl et al.4

Zhi-hui Dong, M.D.
Zhi-gang Yang, M.D., Ph.D.
Tian-wu Chen, M.D.
Yuan-chun Feng, M.D.
Qi-ling Wang, M.D.
Zhi-gang Chu, M.D.
West China Hospital, Chengdu, China
yangzg1117@yahoo.com.cn

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Citing Articles (3)

Citing Articles

1. 1

   Tom Valeo. (2011) An Earthquake, A Tsunami, A Nuclear Disaster: Japanʼs Neurologists on the Front Lines. Neurology Today 11:8, 1
   CrossRef

2. 2

   Tian-wu Chen, Zhi-gang Yang, Zhi-hui Dong, Zhi-gang Chu, Si-shi Tang, Wen Deng. (2011) Earthquake-related Crush Injury versus Non-Earthquake Injury in Abdominal Trauma Patients on Emergency Multidetector Computed Tomography: A Comparative Study. Journal of Korean Medical Science 26:3, 438
   CrossRef

3. 3

   Tian-wu Chen, Zhi-gang Yang, Zhi-hui Dong, Zhi-gang Chu, Jin Yao, Qi-ling Wang. (2010) Pelvic crush fractures in survivors of the Sichuan earthquake evaluated by digital radiography and multidetector computed tomography. Skeletal Radiology 39:11, 1117-1122
   CrossRef