Spinal injuries affecting the thoracic and thoracolumbar spine

Abstract

Thoracic and thoracolumbar fractures range from low impact osteoporotic compression injuries to high-energy fracture/dislocations with spinal cord injury. Assessment can be broadly divided into two sections. Primary assessment should follow the principles of Advanced Trauma Life Support. The secondary assessment should relate to the spinal fracture itself. In determining the optimal treatment, the stability of the injury must be assessed by following a complete clinical and radiographic evaluation.The thoracolumbar junction (T10–L2) is a transitional region between the rigid thoracic spine and the more flexible lumbar spine and hence is susceptible to injury. The thoracic spine (T1–T9) is relatively protected area, due to the rib cage; when injuries do occur they commonly involve visceral and spinal cord injury.Many classifications exist, however the AO and Thoracolumbar Injury Classification and Severity (TLICS) systems are the most clinically useful. Although they are based on thoracolumbar injuries they are commonly extended to thoracic fractures.The majority of fractures can be managed non-operatively with early mobilization and bracing. Surgical stabilization is indicated in unstable fractures. Posterior stabilization with pedicle screws is the most widely used technique; simultaneous decompression can also be achieved with this approach. Anterior surgery has biomechanical advantages and has been shown to be equally effective.