Spine - Thoracolumbar spine

Thoracolumbar Spine Trauma generally forms as a result of high-energy trauma such as road traffic accidents, falls from heights and more. It occurs in individuals with neoplastic, osteoporotic, and metabolic disorders of the spine. Thoracolumbar spine is the transitional zone between the mobile lumbar spine and the stiff thoracic cage. The region is more vulnerable for injury, including dislocation and fracture. Currently, there are several classifications for thoracolumbar burst fracture to predict the prognosis and also guide the treatment options. A thoracolumbar fracture denotes a bone is broken in the middle or lower region of the spine. Some of the thoracolumbar fracture types are compression fracture, burst fracture, chance fracture, and dislocation.

Causes

The most common causes of thoracolumbar fractures are due to violence, sport activities, falls, and accidents. The sudden impact of the back that occurs during the trauma can lead to spine bones to crack or the ligaments to rupture. The beginning trauma may lead to a thoracolumbar fracture and instability, which also lead to the damages in the neurological structures and spine. Most thoracolumbar injuries are irreversible and permanent.

Symptoms

Individuals with thoracolumbar fractures have localized back pain and stiffness. People who have neurologic compression already may have weakness in the legs. They also have injuries to internal organs including liver, intestines, spleen, and kidney, which may lead to abdominal pain and distension.

Physical Findings

The physical findings for individuals with thoracolumbar fractures are variable. Individuals will typically demonstrate profound tenderness and spasm, with significantly decreased lumbar range-of motion. There will be visible swelling and bruising over the fracture site in the back. If the dislocation is severe, there will be a step-off, meaning the bones are not lined up properly which can be seen and felt by the medical experts. Patients may feel numbness in their legs, if the spinal nerves are severely compressed.

Imaging Studies

Normal X-rays of the thoracic and lumbar spine are important to adequately evaluate a thoracolumbar fracture. In some cases, it is difficult to notice a non-displaces or minimally displaced fracture or instability, therefore a computed Tomography scan is commonly taken. A CT scan is the best way to verify that a fracture is present or not. Medical experts recommend to take a CT scan when evaluating a chance fracture, fracture, and a burst fracture. A Magnetic resonance imaging (MRI) test is normally used to evaluate the severity of nerve compression.

Laboratory Tests

There are no specific tests used to diagnose a thoracolumbar fracture. In rare cases, some tests are used to find the metabolic conditions and identify the underlying cause.
Some tests are serum protein electrophoresis and urine protein electrophoresis.

Diagnosis

A thoracolumbar spine fracture can be found in individuals with back pain due to trauma or accident. Some patients with other fractures or injuries will experience pain in other locations.

Treatment

Patients with a thoracolumbar fracture can be treated by both conservative and surgical approaches. Some of the non operative treatments include orthotic treatment and medications. Some surgical options are posterior spinal fusion, anterior decompression and fusion, with or without instrumentation. The main goal of treatment is to preserve or improve neurologic function, provide stability, and decrease pain.

Conclusion

The specific treatment of a thoracolumbar fracture and dislocation depends on factors such as type and location of fracture, severity of fracture, presence of spinal cord, patient's age, medical condition, and associated injuries.