Diagnosis and Management of Thoracolumbar Spine Fractures

by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas Schildhauer, M.L. Chip Routt, and Rick C. Sasso

J Bone Joint Surg AmVolume 85(12):2456-2470

December 1, 2003

©2003 by The Journal of Bone and Joint Surgery, Inc.

The Denis three-column model of spinal injury1.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Lateral radiograph showing the characteristic wedge-shaped appearance of a thoracolumbar compression fracture with mild local kyphosis.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Denis classification of thoracolumbar compression fractures (see text).

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Denis classification of thoracolumbar burst fractures (see text).

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Lateral radiograph showing the typical appearance of a thoracolumbar burst fracture.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Computed tomography scan demonstrating retropulsion of posterior vertebral bone and spinal canal compromise.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Postoperative lateral radiograph showing the posterior instrumentation used in this patient.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Computed tomography scan with sagittal reconstruction showing a thoracolumbar flexion-distraction injury.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Radiographs showing the typical appearance of a thoracolumbar fracture-dislocation.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Magnetic resonance image of a patient with a thoracolumbar injury.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Magnetic resonance image of a patient with a flexion-distraction injury, revealing gas in the posterior subcutaneous tissue overlying the level of the thoracolumbar injury.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Sagittal magnetic resonance image of a patient with a T12 burst fracture and an incomplete neurological injury.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior (Fig. 11-B) and lateral (Fig. 11-C) postoperative radiographs.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Sagittal magnetic resonance image of patient with a complete neurological deficit following a substantial flexion-distraction injury.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.

Following posterior short-segment instrumentation, the fracture was stable and healed uneventfully.

Alexander R. Vaccaro et al. J Bone Joint Surg Am 2003;85:2456-2470

©2003 by The Journal of Bone and Joint Surgery, Inc.