Trauma thoracolumbar spine

1- Classification:

Magerl classification:

* Group A: only the vertebral body is achieved in general by a compression mechanism

* Group B: lesions of the vertebral body with lesions of the posterior elements bending distraction

* Group C: the same anterior and posterior lesions but rotation -> asymmetrical lesions.

A- Group A:

The posterior part of the vertebral body is respected (A1, A2) -> wedge fracture?

comminuted fracture (A3) -> burst fracture. Retropulsion with bone fragments in the spinal canal. Responsible for a large number of neurological damage.

B- Group B:

* The vertebra is literally sheared from back to front -> lesion Chance: the mechanism is forced bending around a front pin (seat belt): hence the name seat belt fracture. These lesions are often accompanied by rupture of visceral pre-vertebral elements (pancreas). this injury can be treated thoracolumbar level by orthopedic method Boehler

* Tear-drop in fracture can be met but less frequently

2- Stories:

– Fractures of the thoracic spine alternate with violent trauma and accompanied 2 times 3 lesions of the rib cage.Complete paraplegia is common at this level.

– Fractures of the thoracolumbar junction represent 60% of all thoracolumbar injuries. At this level the neu-rological complications vary from complete paraplegia with violations of D11 and D12, for purely root-like lesions.

– The lumbar fractures were comminuted fractures of the type -> neurological injury by the tail chaval.

– Fractures of the sacrum: the line is transverse to moderate displacement, nerve complications are kind of sphincter and sexual disorders.

Trauma thoracolumbar spine
Trauma thoracolumbar spine

3- Clinic:

Frankel classification:

A- Group A:

achieved without full motor function or sensory below the injured level

B- Group B:

Achieving complete motor but there is a conservation of sensory function including perineal

C- Group C:

Motor conservation but muscle strength is not usable

D- Group D:

motive and sufficient muscle strength to allow a walk with or without assistance

E- Group E:

No neurological, no weakness, no sensory or sphincter disorders

4- treatment:

A- Neurological damage Presence:

Treatment should be performed in emergency involving the following

* Reduction: the cervical it is obtained by traction; lumbar it is obtained by the positioning on the operating table

* Decompression: this is the removal of bone fragments intraductal from the vertebral body. It is commonly carried in the cervical anterior approach, more frequently at the thoracolumbar level posteriorly.

* Fixing -> by osteosynthesis.

B- Fractures without neurological injury:

The details will depend on the bone injury

* Simple vertebral fractures without injury to the posterior wall can be treated by simply resting and postural reduction -> Magnus

* More severe lesions such burst fracture can be treated with thoracolumbar level by orthopedic Boehler method that combines fracture reduction over a metal framework for progressive … lordosis.

* The deemed unstable lesions (dislocations …) impose the need for a perfect anatomical reduction -> surgery.


* There is no intervertebral disc between the occiput, the atlas and axis. They are connected by a ligament system whose main component is the transverse ligament

* For other vertebrae the main element common ligament posterior vertebral (or posterior longitudinal) is the most important component of spinal stability.

* Dislocation of the occiput (C1) is almost always fatal