Thoraco-lumbar fractures Common injuries. 50% caused by MVA; rest by falls and sporting injuries. Commonly associated injuries; injuries at another level(10%-15%), head and facial injuries (26%), major chest trauma (16%), abdominal trauma (10%), long bones and pelvis(8%).

Classification Major or minor injuries. Minor: #’s of the spinous process, transverse process, and articular surface. Major: Compression #, Burst #, #- dislocation and Flexion-distraction.

Another system of classification (DENIS)  Anterior column.  Middle column.  Posterior column.

Basic anatomy.  Thoracic cage: provides stability against torsion and shear forces. The kyphosis provides absorption of forces during impact.  The T/L junction (T10-L2) resists sagittal, coronal and axial rotation. The junction is straight; cannot absorb impact effectively. Easily injured. Transition area between stiff thoracic and mobile lumbar area; prone to serious injuries like #- dislocation.  Lumbar area: mobile, lordotic (absorbs energy). Facet oriented sagittally; cannot resist forces effectively.

Classification according to mechanism of injury Compression : burst and compression #s Distraction: Flexion-distraction injury. Rotation: shear fractures.

Compression fractures Axial force. Failure of anterior column. Intact middle column. Posterior column may fail in distraction. Two types: lateral and forward flexion injuries. Most are upper plate injuries.

 Burst fractures Axial force. Anterior and middle column fail. Diagnosed on lateral and AP X-rays: o break in posterior cortex; retropulsion oDecreased height of middle column. oIncrease in interpedicular distance.

Fracture-dislocation  All 3 columns fail.  Forces: compression, rotation, distraction or shear ( /// dog bite).  Three types; flexion-rotation, rotation, shear, and flexion-distraction.  High incidence of neurological injury.

Classification of neurological injury According to Frankel Grading:  A. Complete neurological injury.  B. Sensory sparring.  C. Motor useless.  D. Motor useful.  E. Intact.

Management principles. Pre-hospital : first aid. Done by paramedic. ABC, immobilization of spine, and careful and safe patient transportation to hospital. Hospital management : continue with ABC if necessary. Do preliminary survey. Avoid prolonged spinal immobilization( not > 4 hours. Assess the neurology. Repeat it after 24 hours(?): spinal shock phases.

Investigations X-rays : according to your assessment. Additional investigations as necessary; CT SCAN, MRI, CYSTOGRAM.

Treatment Steroids: within 8 hours of injury, continue for 23 hours. Definitive treatment:  Conservative: stable spine (?)  Surgical : unstable spine(?)  REHABILITATION.