Thoracolumbar fractures account for 50% of spinal fractures and often occur between the T9 and L2 vertebrae. They are commonly caused by high-energy trauma like motor vehicle accidents or falls. Assessment involves neurological examination, imaging like x-rays and CT scans to evaluate bone injury and MRI to assess soft tissues. Treatment depends on factors like degree of vertebral compression and kyphosis, with non-operative options for mild cases and surgical stabilization and fusion for more severe injuries or neurological compromise. Rehabilitation focuses on restoring function, preventing complications, and bracing to solidify healing.

1. Thoracolumbar
Fractures

2. Thoracic and lumbar fractures account for 50% of
all spinal traumatic fractures.
• Incidence.
4-5 per 100,000.
18 - 35 years.
Male Female = 4:1
Neurologic injury  25% of cases.
• 65% of TL#s occurs between the T9&L2 vertebrae.
(thoracolumbar Junction)

4. Functional spinal unit
Composed of:
• 2 adjacent vertebrae
• Facet joint
• Inter vertebral disc
• Intervening ligaments
4
This unit is responsible for Movement of spine

5. Thoracic Spine
• Kyphotic Curve.
• Ribs  more stiffness, resist rotation.
• T11,T12 have floating ribs;
No costotransverse articulations.
No sternal attachement.
•Facet orientation  limited
flexion/extension.
•Canal is relatively small.

6. Lumbar Spine
• Lordotic Curve.
• Large discs  More mobility
• Spinal canal wider.
• Spinal cord ended at L1.
• Facet orientation  more
flexion/extension.

7. •Transition between the stiff kyphotic thoracic spine
and mobile lordotic lumbar spine.
• In trauma;
Thoracic spine deforms into kyphosis,
Lumbar spine into lordosis leaving,
Junction exposed to pure compression.
• T11, T12 are less stable  less resistance to
rotation  more stress.
Why Thoraco-lumbar junction is more succeptible?

8. ETIOLOGY
• High energy trauma (RTA 50%)
• Falls.
• Sports accident.
• Gunshot injury.
• Osteoporosis
• Tumors
• Weak bone(malnutrition,renal,RA,DM,endocrine).

9. – 16% major chest injury
– 10% major abdominal injury
– 8% long bone/ pelvic fractures
Spinal fracture should be suspected in;
1. Comatosed patient.
2. High energy trauma.
3. Evidence of neurological deficit.
4. Multiple injuries:

10. Missed TL#s reach 5%, And reach 22% in cervical fractures.
The main causes are,
• Poly trauma.
• low level of suspicion.
• Intoxication unconsciousness
• Failure to take proper radiographs.
• Failure to interpret the x ray.

11. CLASSIFICATION

12. Three column theory
ANTERIOR COLUMN
MIDDLE COLUMN
POSTERIOR COLUMN

14. • 45% of TL#s.
• Anterior column failure
(Anterior or lateral flexion)
• Middle, Post. Column intact.
• Usually no Neurological deficits.
COMPRESSION (WEDGE) FRACTURE

17. Burst fractures
• 15 % of TL#s
• Anterior& middle column failure.
(Axial compression)
• Most common at T/L junction
• Neurological deficit.

20. FLEXION-DISTRACTION = SEAT-BELT-TYPE = CHANCE #
• Posterior &middle columns failure.
(hyperflexion then tension forces)
• Anterior column 
- partial damage.
- functions like a hinge.

23. Fracture-Dislocation
• Failure of all columns
(compression, tension,
rotation, or shear).
• anterior hinge is disrupted.
• Dislocation.
• Severe neurological deficit.

26. Approach to Spine
Trauma

27. Pre Hospital Care
• Proper extraction & Immobilization;
Cervical collar
Hard board (log roll)
Sand bag
Tape
• Airway protection.
• Rapid & safe transfer  for suitable facilities.

28. Emergency Assessment
ABCs & Immobilization Hemodynamically stable
Secondary Survey:
1-Log roll technique
2-Remove the spinal board
3-Remove cervical collar carefully
4-Brief history (Mechanism, movement, position)

29. Inspection
• Clothes removed.
• Bleeding , abrasion or lacerations.
• Deformity, Swelling.
• Limb asymmetry (movements).
• Chest expansion, Paradoxical breathing.

30. Palpation
1. Tenderness.
2. Swelling.
3. Interspinous widening (>7mm).
4. Malialignement of spinouse process .
5. Step off.

31. Initial Neurological
Assessment

32. Initial Assessment:
Motor Examination

33. Initial Assessment:
Motor Examination

34. Initial Assessment:
Sensation

35. Initial Assessment:
Reflexes
1. Babiniski sign.
2. Perianal/perineal sensation
3. Rectal tone
4. Cresmatic reflex

36. RADIOLOGICAL ASSESMENT

37. X-RAYS Lateral View
• Alignment.
• Contour of bodies.
• Disc spaces.
• Angulation.
• Encroachment on canal.
• Loss of vertebral body height.

38. X-RAYS Lateral View
• Measurement of
degree of vertebral
body compression.

39. • Look at how the ant.&
post. aspects of the
body line up.
X-RAYS Lateral View

40. X-RAYS Lateral View
• Measure Kyphosis.
• Measure from
closest intact
endplates.

41. • Alignment
• Symmetry/ Shape of
pedicles
• Interpedicular distance
• Position of spinous process
• Contour of bodies
X-RAYS A-P view

42. X-RAYS A-P view
• Lateral vertebral body height.
• Interpedicular
distance.
• Distance between the spinous
processes.

43. CT Scan
• Accurate assessment
of bone.
1- Comminution.
2- Canal compromise.
3- Dislocation.

44. MRI
• Accurate assessment
of soft tissue.
1- Neurological deficits.
2- Cord lesion.
3- Ligament injury.
4- Disc herniation.
5- Hematoma.

45. Treatment

46. Goals
1. Maximise neurological recovery .
2. Maintain or restore spinal alignment.
3. Obtain a healed and stable spinal column.
4. Prevent future deformity.

47. Spinal Cord Injury
Methylprednisolone
• 30mg/kg iv bolus over 15min.
• 5.4 mg/kg/h infusion over 23 hrs (first 3 hours).
• 5.4 mg/kg/h for 47hrs (if > 3 – 8 hrs passed).
Proton pump inhibitor & LMW Heparin

48. Non-operative treatment
Indications:
• Ant. vertebral height loss < 40%.
• Canal compromise < 40%.
• kyphosis < 25 degrees.
Bed Rest
• Strict bed rest for 3- 4 weeks.
• Avoid flexion, sit-ups, & spinal rotation.
• Avoid weight bearing.
• Bed rolling encouraged.

49. Bracing
• Treated with brace for 6-8 weeks.
• Wear on whenever upright.
• Ambulation & Transfers.
• Solid healing  8-12 weeks.

50. Operative treatment
Indications:
• Ant. vertebral height loss > 40%.
• Canal compromise > 40%.
• Kyphosis > 25 degrees.
• Neural compression.
Aim
• Neural Decompression.
• Stabilization.
• Solid fusion.

51. Surgical options
Anterior FixationPosterior Fixation

52. Vertebroplasty

53. Kyphoplasty

54. Rehabilitation
• Physiotherapy.
• Bladder dysfunction: Intermittent cath.
Supra-pubic cath.
• Bowel dysfunction: high fluids, fibers, Prokinetic.
• Spasticity: Stretching exercises, Baclofen, surgical.
• DVT prevention.
• Chest physiotherapy.
• Bed sore prevention: Postural change/2h, Air mattress,
High protein diet.