Thoracolumbar Spinal Injuries

✔ Spinal fractures are frequently located at the thoracolumbar junction for biomechanical reasons ✔ The AO classification has gained widespread acceptance in Europe for the grading of thoracolumbar fractures: Type A: vertebral compression fractures; Type B: anterior and posterior column injuries with distraction; Type C: anterior and posterior element injury with rotation ✔ The initial focus of the physical examination of a patient with a spinal injury is on the vital and neurological functions, because effective resuscitation is critical to the management of polytraumatized patients and patients with spinal cord injury ✔ The imaging modalities of choice are standard radiographs and CT scans. A CT scan should routinely be made to visualize bony injury. MRI is helpful to diagnose discoligamentous injuries and to identify a possible cord lesion ✔ Primary goals of treatment are prevention and limitation of neurological injury as well as restoration of spinal stability, regardless of whether operative or non-operative therapy is chosen ✔ Secondary goals consist of correction of deformities, minimizing the loss of motion, and facilitating rapid rehabilitation ✔ Early stabilization and fusion is generally accepted for patients with unstable fractures and neurological deficits ✔ The optimal treatment for patients with less instability, moderate deformity and absence of neurological compromise is not based on scientific evidence and remains a matter of debate. ✔ Good clinical outcome can be achieved with non-operative as well as operative treatment