Thoracolumbar spine fracture

Last revised by Joachim Feger on 23 Aug 2021

Thoracolumbar spine fractures are often the result of significant blunt trauma such as motor vehicle accidents or falling from a height. Fractures in this region range from non-complex to highly complex and will vary in prognosis.

Males are affected more commonly than females with a peak incidence between 20-40 years of age 1

Because thoracolumbar injuries are often due to blunt trauma or high-velocity injuries there can be myriad associated injuries such as 1:

The thoracolumbar spine can be divided into the thoracic spine, the thoracolumbar junction (T10-L2) and the lumbar spine. The thoracic spine is the more rigid of these structures and therefore requires significant force to cause injury. Whereas the lumbar spine, with its thick intervertebral discs and sagittally-oriented facet joints, and the lack of the thoracic cage, is comparatively more mobile. The thoracolumbar junction is the most common region of thoracolumbar fractures due to that transition point of increased mobility 2.

  • compression fracture
    • compression fracture of the vertebral body compressing the anterior component (wedge-shaped)
    • often due to axial loading 
  • burst fracture 
    • unstable compression fracture through the entire vertebral body 
    • commonly occur at L1 with the majority (~90%) occurring from T9-L5 3
    • result of high energy axial loadings such as falling from a height or motor vehicle accident 3
  • posterior column fracture 
    • a fracture that extends through the vertebral arch
    • 90% occurring from T11-L4 4
    • result of higher velocity trauma
    • associated with intracranial hemorrhage 
  • chance fracture
    • a flexion-distraction injury where the anterior column is compressed and the posterior and middle columns are distracted 
    • the majority occur at the thoracolumbar junction 
    • typically result of forced flexion anterior to the abdomen i.e. a seatbelt
    • associated with intra-abdominal injuries 4
  • thoracic spine fracture-dislocations
    • highly unstable vertebral fracture with dislocation of facet joints and/or the intervertebral disc space
    • result of high energy trauma 
  • translation-rotation injuries 2
    • horizontal displacement or rotation of one vertebral body to another
    • the result from torsional and shear forces
  • transverse process fracture
    • stable fracture of the transverse process most commonly occurring in the lumbar spine 
    • often multiple when present 

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Cases and figures

  • Case 1: anterior wedge fracture: L1
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  • Case 2: burst fracture
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  • Case 3: chance fracture
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  • Case 4: T7/8 fracture-dislocation
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  • Case 5: translation-rotation thoracic spine injury
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  • Case 6: transverse process fracture
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  • Case 7
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