View source for Thoracic and lumbar fractures and dislocations

==Background==
*Injury to thoracic spine necessitates severe force
**thoracic spine has enhanced stiffness secondary to articulations with the rib cage
**When spinal cord injury occurs usually complete
**thoracic spinal canal is narrower than in other regions, increased risk of cord injury
*Important to evaluate for thoracic spine injuries and aortic injuries in the setting of blunt chest trauma with mediastinlal widening 
*Follows the three column model - [[Unstable spine fractures‎|Stable]] if two or more of the spinal columns are intact:
**Anterior (anterior longitudinal ligament, annulus fibrosus, ant. half of the vertebral body)
**Middle (posterior longitudinal ligament, posterior annulus fibrous, and post. half of vertebral body
**Posterior (supraspinous and interspinous ligaments, ligamentum flavum, facet joint capsule)
*Unstable if:
**50% loss of vertebral height
**Kyphotic angulation around the fracture:
***>30' for compression fracture
***> 25' for burst fracture 
**Neurologic deficit

{{Vertebral fractures and dislocations types}}

==Clinical Features==
*Typically pain over site of injury

==Differential Diagnosis==
{{Thoracic trauma DDX}}
{{Lower back pain DDX}}

==Evaluation==
[[File:T12compressionfracMark.png|thumb|[[Thoracic compression fracture]] of T12.]]
===Workup===
*Type and screen/cross, labs including pancreatic enzymes if thoraco-lumbar location

*Indications to Image Thoracic and Lumbar Spine after Trauma
**Mechanism
***Gunshot, High energy trauma, Motor vehicle crash with rollover or ejection, Fall >10 ft or 3 m, Pedestrian hit by car
**Physical Exam
***Midline back pain, Midline focal tenderness, Evidence of spinal cord or nerve root deficit
**Associated injuries
***Cervical fracture, ribe fracture, aortic injuries, hollow viscus injuries
*Plain radiographs or CT scan to evaluate for body abnormality
*Can reformat Chest and Abdomen CT to look at thoracic, lumbar spine
*MRI is diagnostic test of choice to evaluate patients with nerve injury
*CT myelography alternative when MRI unavailable
*anterior vertebral body compression fracture with extension through middle of vertebral body into posterior wall
*Compression fracture + increased posterior interspinous spaces caused by distraction
10% of patients with a spine fracture have second fracture in a different segment


CT IF:
*Compression
*Wedge
*>50% height (rule out middle column & burst)

===Diagnosis===

==Management==
*Spinal precautions
*Consult ortho or neurosurgery (institution dependent)
*Stable fractures 
**TLSO brace in discussion with consulting service
*Unstable fractures
**Emergency operative repair unless medically unstable

==Disposition==


==See Also==
*[[Spinal Cord Trauma]]
*[[Vertebral fractures]]

==External Links==
*[https://www.east.org/education/practice-management-guidelines/thoracolumbar-spinal-injuries-in-blunt-trauma%2C-screening-for EAST Guidelines for screening for thoracolumbar injuries]

==References==
<references/>

[[Category:Trauma]]
[[Category:Neurology]]
[[Category:Orthopedics]]