Evaluation and Treatment of Thoracolumbar Junction Trauma

The thoracolumbar junction is the most common area of injury to the axial skeleton. A wide variety of injury patterns and clinical presentation is encountered in this region, and multiple classification systems have been devised. According to the three- column theory of Denis, injury to the anterior column results in a compression fracture. Injury to both the anterior and middle col- umns results in a burst fracture with possible retropulsion of bone posteriorly into the spinal canal. Injury to all three columns results in either a flexion distraction injury or a fracture dislocation. Since the spinal cord ends in this region, neurological injuries can result in either a cord or a cauda equina lesion, which vary in their prognoses. Significant controversy exists regarding surgical inter- vention for these fractures. This paper reviews the general prin- ciples of evaluation and treatment of thoracolumbar trauma.

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