Thoracolumbar Spine Trauma

synonyms:

Thoracolumbar Spine Trauma ICD-9

Thoracolumbar Spine Trauma Etiology / Epidemiology / Natural History

• Typically high energy trauma (MVC, falls from height) in young patients. Low-energy osteoporotic fractures in elderly patients.
• Injuries generally occur at the T12-L1 thoracolumbar junction

Thoracolumbar Spine Trauma Anatomy

• Thoracic Spine: average 35° of kyphosis
• Lumbar Spine: average 40° lordosis (primarily L4-S1).
• Spinal Cord (adult): extends from foramen magnum to L1 vertebral body.
• Blood supply to thoracic spinal cord: one anterior and two posterior spinal arteries. 10% of patients have predominant anterior radicular artery of Adamkiewicz which originates from on the of the left T8-L2 intercostal arteries.

Thoracolumbar Spine Trauma Clinical Evaluation

• Palpate entire spine for tenderness / step off.
• Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
• Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
• See ASIA form.

Thoracolumbar Spine Trauma Xray / Diagnositc Tests

• A/P and Lateral views of the thoracic and lumbar spine.
• CT Thoracolumbar spine: Better specificity, sensitivty and safety than screening xrays, but exposes patients to 6x more radiaiton. (Inaba K, J Trauma 2006;60:915).
• MRI: indicated for neuro deficit, suspicious of instability or HNP, pre-op evaluation. PLC injury indicated by increased signal on T2-weighted images.

Thoracolumbar Spine Trauma Classification / Treatment

• Any trauma pt with suspected spine injury should be immobilized on a spine board with Thoracolumbar collar and log-roll precautions until the c-spine has been cleared.
• Thoracolumbar Injury Classification and Severity Score (Lee JY, J Orthop Sci 2005;10:671).
• TLICSS<3: short period bedrest followed by mobilization in TLSO ro Risser-like body cast with spine in hyperextension for 10-12 weeks. See Differential Diagnosis for specific injuries / treatments.
• TLICSS <5: surgery

Thoracolumbar Spine Trauma Differential Diagnosis

• Burst Fracture
• Compression Fracture
• Spinal Cord Injury

Thoracolumbar Spine Trauma Complications

Thoracolumbar Spine Trauma Follow-up Care

Thoracolumbar Spine Trauma Review References

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