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Thoracolumbar spinal injuries

Thoracolumbar spinal injuries involve traumatic injuries to the spine, most commonly around the thoracolumbar junction (T10–L2), where the relatively rigid thoracic spine transitions to the more mobile lumbar spine. Injuries range from simple compression fractures to unstable burst, distraction, and translational injuries with possible neurological compromise. Assessment focuses on fracture morphology, posterior ligamentous complex integrity, and neurological status, commonly using CT, MRI, and systems such as TLICS or AO Spine classification.

Thoracolumbar spinal injuries are traumatic injuries affecting the thoracic and lumbar spine, with the T10–L2 junction being especially vulnerable because of the transition from the rigid, kyphotic thoracic spine to the more mobile, lordotic lumbar spine. They commonly occur after high-energy mechanisms such as road traffic accidents, falls from height, and crush injuries. Clinical assessment includes evaluation for spinal pain, deformity, tenderness, and a detailed neurological examination, including motor power, sensation, reflexes, and sacral function. Associated injuries to the chest, abdomen, pelvis, and extremities should also be actively sought. CT scanning is the main imaging modality for defining fracture morphology, canal compromise, and alignment. MRI is useful when there is neurological deficit or concern regarding the spinal cord, conus medullaris, cauda equina, intervertebral discs, or posterior ligamentous complex (PLC) injury. Common injury patterns include compression fractures, burst fractures, flexion-distraction injuries, and fracture-dislocations. Classification systems such as the Thoracolumbar Injury Classification and Severity Score (TLICS) consider fracture morphology, PLC integrity, and neurological status to help guide management. Stable injuries without neurological deficit may often be treated conservatively with analgesia, mobilization, and selective bracing. Unstable fractures, progressive deformity, significant neurological compromise, or major PLC disruption may require surgical decompression and stabilization, most commonly with posterior pedicle-screw fixation. The goals of treatment are to protect neurological function, restore spinal alignment and stability, prevent progressive deformity, facilitate early mobilisation, and achieve the best possible long-term functional outcome.

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