Importance of load sharing column and canal violation in the management of thoracolumbar burst fractures.

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Abstract

Introduction: The ideal classification of spinal fractures should include every kind of fracture and suggest patterns of treatments. Vaccaro et al. proposed a classification and treatment rules according to a comprehensive severity score. In this one, fractures with exclusive lesion of the vertebral body, burst fractures, without either damage of the posterior ligament band or neurological deficit, are considered for conservative treatment. Objective: To demonstrate that some fractures, with an exclusive lesion of the load sharing column, the vertebral body, without any posterior ligament destruction, may be unable to share physiological loads and if associated with great compression of spinal canal, carries so much risk of neural damage that it should be submitted to surgery. Methods: This review is based on the discussion of the literature and is illustrated by a case description. Results: We demonstrate the importance of inclusion of the concepts, load sharing column and intensity of canal encroachment in therapeutic decision regarding thoracolumbar fractures. Conclusions: Patients with canal compression ≥ 50% should be considered for surgery. Patients with lesser degrees of canal encroach may be submitted to erect radiography and operated if there is an additional loss of vertebral body height or neurological symptoms.