Management of thoracolumbar spine fractures |
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| Authors: | Kirkham B. Wood Weishi Li Darren S. Lebl Avraam Ploumis |
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| Affiliation: | 1. Massachusetts General Hospital, 55 Fruit St, Suite 3800, Yawkey Bldg, Boston, MA 02114-2621, USA;2. Hospital for Surgery, 535 E 70th St, New York, NY, USA;3. University of Ioninna, P.O. Box 1186, 45110 Ioannina, Greece;1. Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan;2. Department of Surgical Nursing, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan;1. Department of Orthopaedics and Traumatology, Hacettepe University, Hacettepe Hastaneleri, 06100 Sihhiye, Ankara, Turkey;2. Acibadem Maslak Hastanesi, Büyükdere Cad. No: 40 34457 Maslak, ?stanbul, Turkey;1. Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 3021, Kansas City, KS 66160, USA;2. Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada;3. Toronto Western Hospital, 399 Bathurst St, #4W-449, Toronto, ON, Canada;4. Department of Health Services, University of Washington, Box 359455, 4333 Brooklyn Ave NE, Rm 14-315, Seattle, WA 98195-9455, USA;5. Department of Orthopaedic Surgery, Emory University, Emory Orthopaedics & Spine Center, 59 Executive Park South, Atlanta, GA 30329, USA;6. Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107-4216, USA;7. Department of Orthopaedics, University of Utah, University Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA;8. Department of Neurological Surgery, University of Virginia Health System, PO Box 800212, Charlottesville, VA 22908-0212, USA;9. Department of Orthopedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA;10. Boston Spine Group, 299 Washington St, Newton, MA 02458, USA;11. Department of Orthopaedics, University of Washington, Orthopaedic Trauma Surgery Clinic at Harborview, Harborview Medical Center, 1 West Clinic, Box 359798, 325 Ninth Ave, Seattle, WA 98104, USA;12. Spine Education and Research Institute, Center for Spinal Disorders, 9005 Grant St., Suite 200, Thornton, CO 80229, USA;13. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, 75 Francis St., Boston, MA 02115, USA;14. Department of Orthopedic Surgery, Indiana Spine Group, 8040 Clearvista Parkway, Suite 450, Indianapolis, IN 46256, USA;15. The CORE Institute, Center for Orthopedic Research and Education, 3010 W. Agua Fria Fwy #100, Phoenix, AZ 85027, USA;p. Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 7-109, 600 North Wolfe St., Baltimore, MD 21287, USA;1. Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti South Road, Chaoyang District Beijing 100020, China;2. Department of Orthopedic Surgery, Shenzhou Hospital, Shenyang Medical College, 20 North nine Road, Heping District Shenyang 110002, China;3. Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti South Road, Chaoyang District Beijing 100020, China;1. Thomas Jefferson University School of Medicine, Philadelphia, PA 19107, USA;2. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;3. Department of Neurosurgery, Temple University, Philadelphia, PA 19140, USA;4. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107, USA;5. Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA |
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| Abstract: | Background contextTraumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability.PurposeTo review the most current information regarding the pathophysiology, injury pattern, treatment options, and outcomes.Study designLiterature review.MethodsRelevant articles, textbook chapters, and abstracts covering thoracolumbar spine fractures with and without neurologic deficit from 1960 to the present were reviewed.ResultsThe thoracolumbar spine represents a unique system from a skeletal as well as neurological standpoint. The rigid rib-bearing thoracic spine articulates with the more mobile lumbar spine at the thoracolumbar junction (T10 - L2), the site of most fractures. A complete examination includes a careful neurologic examination of both motor and sensory systems. CT scans best describe bony detail while MRI is most efficient at describing soft tissues and neurological structures. The most recent classification system is that of the new Thoracolumbar Injury Classification and Severity Score. The different fracture types include compression fractures, burst fractures - both stable and unstable -, flexion-distraction injuries and fracture dislocations. Their treatment, both operative and non-operative depends on the degree of bony compromise, neurological involvement, and the integrity of the posterior ligamentous complex. Minimally invasive approaches to the care of thoracolumbar injuries have become more popular, thus, the evidence regarding their efficacy is presented. Finally, the treatment of osteoporotic fractures of the thoracolumbar spine is reviewed, including vertebroplasty and kyphoplasty, their risks and controversies, and senile burst fractures, as well.ConclusionsThoracolumbar spine fractures remain a significant source of potential morbidity. Advances in treatment have minimized the invasiveness of our surgery and in certain stable situations, eliminated it all together. |
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| Keywords: | Thoracolumbar Spine Fracture Fracture-dislocation Fusion Kyphoplasty Surgery Outcomes |
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