Thoracolumbar Fracture

Question 1

Where in the spine is most commonly injured?

Answer 1

The thoracolumbar junction (T11–L2) is the most commonly fractured region, with 40-60% of all spinal fractures occurring at these levels.

Question 2

Briefly describe the 3 columns of the spine

Answer 2

The spine may be thought of as consisting of three columns, which are important when assessing the stability of a fracture:

• Anterior column
  
  • Anterior longitudinal ligament and the anterior half of the vertebral body and disc
• Middle column
  
  • Posterior half of the vertebral body and disc, and posterior longitudinal ligament
• Posterior column
  
  • Comprised of the posterior elements (the posterior ligamentous complex, including the facet joint capsule, ligamentum flavum, and interspinous and supraspinous ligaments) and the intervening vertebral arches

Question 3

Briefly describe the ligaments of the spine

Answer 3

Question 4

What classficiation system is used in thoracolumbar fractures?

Answer 4

AO classification.

Question 5

Briefly describe the AO classification of thoracolumbar fractures

Answer 5

Thoracolumbar fractures can be classified based on their morphology according to the AO classification:

• Type A- compression injuries
• Type B- distraction injuries
• Type C- translation injuries

Question 6

What is a burst fracture?

Answer 6

A burst fracture occurs when there is a substantial compressive force acting through the anterior and middle column of the vertebrae, resulting in retropulsion of bone into the spinal canal.

This can result in potential spinal cord injury. These fractures can involve one end plate (incomplete burst) or both endplates (complete burst).

Question 7

What is a chance fracture?

Answer 7

Chance fractures are vertebral fractures that result from excessive flexion of the spine and involve all three spinal columns. These are unstable injuries and will often need surgical intervention to stabilise.

They classically occur following head-on road traffic accidents in which the affected person is wearing only a lap belt, therefore are commonly associated with concurrent abdominal injuries.

Question 8

What are the clinical features of thoracolumbar fractures?