Thoracolumbar fracture Case presentation Presenters name Arial 24

Thoracolumbar fracture Case presentation Presenter‘s name Arial 24 pt Meeting Arial 24 pt Presenter‘s title Arial 20 pt City, Month, Year Arial 20 pt

45 -year-old man • • Fell from scaffolding Neurologically intact No trunk control No other injuries

45 -year-old man • • • Fell from scaffolding Neurologically intact No trunk control No other injuries What is your management plan? • Further imaging?

45 -year-old man • CT scan • Further imaging?

45 -year-old man • MRI • PLC intact? • Management?

Intraoperative, prior to correction Intraoperative, after correction

Treatment • Nonoperative treatment • No neurological abnormality • < 50% loss of body height • < 30º kyphosis, T 11–L 2 • NB: acceptable kyphosis varies in the thoracic and lumbar regions • Operative treatment if: • Wedge/collapse more than 50% of body height • > 30º kyphosis, T 11–L 2 • Neurological compromise

Neurological compromise • Surgery indicated acutely if: • Persistent canal compromise and spinal shock or partial neurological deficit • Patient fit for surgery • Resources and skills of the team appropriate for the required surgical treatment • Surgery indicated electively if: • Persistent canal compromise, no spinal shock, and complete neurological deficit

Neurological compromise • Timing of surgery is controversial • Time of operation makes no difference? • Before 24 hours? • Before 12 hours? • New evidence to support early intervention and cord decompression • Better recovery with decompression within 24 hours • Benefits of surgery within 12 hours are not proven

Take-home messages • Type A fractures are compression fractures with intact discoligamentous structures • Clinical evaluation should assess neurological status (ASIA) • Imaging should assess mechanical signs of instability, such as comminution and anterior column support • Surgical decision based on two main issues: • Neurological status • Fracture morphology

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