Usually occurs as a result of high-energy trauma (e.g., road traffic accidents, falls from heights).
May occur spontaneously in patients with osteoporotic, neoplastic, or metabolic disorders of the spine.
Initial on-the-scene evaluation involves performing primary survey with ABC assessment with C-spine immobilization and hemorrhage control.
It is important to evaluate and assess thoracolumbar fractures for instability.
If the decision to operate is made, this should occur earlier rather than later.
Thoracolumbar fractures are breakages in the vertebrae of the spinal column in the thoracic and lumbar regions. They may be associated with disruption of the ligamentous complexes, and can result in instability or compression of neural structures. Thoracolumbar fractures are the usual outcome of thoracolumbar trauma. Other outcomes include traumatic disk prolapse, ligamentous injury, and epidural hematoma causing pressure on the spinal cord or nerve roots; these occur very rarely without a fracture. This topic focuses on thoracolumbar spine fracture.
History and exam
- history of mechanical trauma
- past medical history of osteoporosis or neoplasm
- back pain
- acute numbness/paresthesia
- muscle spasticity/clonus (hypertonicity) or hypotonia
- hyperreflexia or hyporeflexia
- Hoffman sign
- positive Babinski sign
- spinal deformity
- loss of anal sphincter reflex
Besnik Nurboja, BSc, MBBS, MD (Res), MRCS, MCEM
St Thomas’ Hospital
BN declares that he has no competing interests.
David Choi, FRCS(SN)
Consultant Neurosurgeon and Spinal Surgeon
The National Hospital for Neurology and Neurosurgery
DC declares that he has no competing interests.
Nils Ake Nystrom, MD, PhD
Department of Orthopedic Surgery and Rehabilitation
Division of Plastic and Reconstructive Surgery
University of Nebraska Medical Center
NAN is an author of a reference cited in this monograph.
David W. Rowed, MD, FRCSC
Professor of Surgery
Division of Neurosurgery
University of Toronto
Department of Otolaryngology
Sunnybrook Health Sciences Centre
DWR declares that he has no competing interests.
Renn Holness, BSC, MBBS (Hons), FRCSC
Division of Neurosurgery
Dalhousie University & QEII Health Sciences Centre
RH declares that he has no competing interests.
Andre Tomasino, MD
Department of Neurological Surgery
Weill Cornell Medical College
New York-Presbyterian Hospital
AT declares that he has no competing interests.
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