Mind the Gap: Interpedicular Widening as a Superior Predictor of Neurological Deficit Over Kyphosis in Thoracolumbar Burst Fractures

Purpose: To compare the predictive value of interpedicular distance (IPD) widening, local kyphosis, and anterior vertebral body height loss in assessing injury severity and neurological deficit in traumatic thoracolumbar burst fractures. Methods: A retrospective analysis of 56 patients with traumatic thoracolumbar burst fractures was conducted. Radiographic parameters including interpedicular distance at the fracture level, average interpedicular distance, local kyphosis angle, and anterior vertebral body height were recorded. Neurological status was assessed using the ASIA Impairment Scale. Correlation analyses were performed to evaluate the relationship between radiographic measures and neurological status. Results: The percentage increase in interpedicular distance showed a moderate negative correlation with ASIA grade (r = -0.51), indicating worse neurological status with greater widening. Local kyphosis was also negatively correlated with ASIA grade (r = -0.40). A weak positive correlation was found between IPD widening and anterior vertebral body height loss (r = 0.25), while the correlation between height loss and ASIA grade was weak (r = -0.19). Conclusion: Among the radiographic parameters studied, interpedicular distance widening correlated most strongly with neurological deficit in thoracolumbar burst fractures, followed by local kyphosis. Loss of anterior vertebral height showed weaker association. These findings suggest that IPD widening may be a more sensitive indicator of injury severity in clinical evaluation.