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Thoracolumbar Fracture Dislocation

A thoracolumbar fracture-dislocation involves disruption of all three spinal columns and is an inherently unstable high-energy injury that is nearly always a complete spinal cord injury. Imaging including X-rays, CT, and MRI are used to evaluate the fracture pattern and spinal cord. Treatment may involve nonoperative bracing or surgical stabilization and decompression depending on the severity and completeness of the spinal cord injury.

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979 views2 pages

Thoracolumbar Fracture Dislocation

A thoracolumbar fracture-dislocation involves disruption of all three spinal columns and is an inherently unstable high-energy injury that is nearly always a complete spinal cord injury. Imaging including X-rays, CT, and MRI are used to evaluate the fracture pattern and spinal cord. Treatment may involve nonoperative bracing or surgical stabilization and decompression depending on the severity and completeness of the spinal cord injury.

Uploaded by

puchio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Thoracolumbar Fracture-Dislocation

A thoracolumbar fracture-dislocation is an inherently unstable injury pattern that


involves disruption of all three spinal columns. These high-energy injuries are
nearly always complete spinal cord injuries and are typically managed operatively
for stabilization.

History (Most Likely Unable to Obtain)

• Do you have any strength or sensation distal to injury level?


• Do you have bowel or bladder function?

Physical Exam

• ATLS evaluation (Appendix A)


• Complete Neurologic Exam (Appendix A)
° Bulbocavernosus reflex testing is necessary to differentiate spinal shock from SCI

Diagnosis

Imaging

• T/L XRs—AP, lateral


• T/L CT—Required to evaluate fracture pattern (Fig. 1)
• T/L MRI—Necessary for visualizing the spinal cord and posterior ligamentous
complex

© Springer International Publishing Switzerland 2017 87


M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_24
88 M.C. Makhni et al.

Fig. 1 Fracture-dislocation

Treatment Plan

Nonoperative

• Custom-fitted thoracic-lumbar-sacral orthosis (TLSO)


° Critically ill or unstable patients

Surgical

• Percutaneous posterior instrumentation 1–2 levels above and below the injury
site (damage control)
° Patients with complete spinal cord injury
° Goals of stabilization:
– Facilitate nursing care and rehabilitation
– Maintain alignment to prevent further decompensation
• Open posterior decompression, fusion, and instrumentation
° For patients with incomplete spinal cord injury requiring decompression

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