Thoracolumbar fracture Case presentation Presenters name Arial 24

$Thoracolumbar fracture Case presentation Presenter‘s name Arial 24 pt Meeting Arial 24 pt Presenter‘s$

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

27 -year-old man • Motor vehicle accident • No neurological loss • No other significant injuries

27 -year-old man

27 -year-old man • Status of PLC? • Further imaging?

27 -year-old man • Axial CT • Further imaging?

27 -year-old man • MRI • Plan?

27 -year-old man Intraoperative image showing PLC disruption

27 -year-old man Intraoperative image • In OR within 12 hours of injury Preoperative image

27 -year-old man Postoperative CT and lateral image 15/12 postoperative

19 -year-old woman • • • Motor vehicle accident Back pain Neurologically intact No other injuries Posterior tenderness • Nature of injury? • Other imaging?

19 -year-old woman

19 -year-old woman • Your plan?

$Treatment outline for “Type B” fractures B 1–posterior monosegmental bony disruption • Posterior surgery$

Treatment outline for “Type B” fractures B 1–posterior monosegmental bony disruption • Posterior surgery indicated to restore posterior tension band • Fusion generally not required as stability achieved by bony healing • If no fusion performed, plan to remove instrumentation

Postoperative x-rays Post-R/O rods

$Treatment outline for “Type B” fractures B 2–PLC disruption • Posterior surgery indicated to$

Treatment outline for “Type B” fractures B 2–PLC disruption • Posterior surgery indicated to restore posterior tension band • Generally requires fusion of disrupted segment • Anterior reconstruction may be indicated if significant anterior column disruption/comminution

$Treatment outline for “Type B” fractures B 2–PLC disruption • Anterior reconstruction may be$

Treatment outline for “Type B” fractures B 2–PLC disruption • Anterior reconstruction may be indicated if significant anterior column disruption/comminution

$Treatment outline for “Type B” fractures B 2–PLC disruption • Anterior reconstruction may be$

Treatment outline for “Type B” fractures B 2–PLC disruption • Anterior reconstruction may be indicated if significant anterior column disruption/comminution • If anterior reconstruction, limit fusion to one motion segment

$Treatment outline for “Type B” fractures B 3–anterior disruption • Unusual injury • May$

Treatment outline for “Type B” fractures B 3–anterior disruption • Unusual injury • May be in akylosed spine • Approach dependent on fracture configuration

Take-home messages • Generally surgical treatment • B 1 and B 2: usually posterior approach for adequate treatment • B 1 and B 2: occasionally requires 360º or anterior approach to reconstruct anterior column • Aim for monosegmental fusion • Plan to remove instrumentation when spanning nonfused segments

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