Thoracolumbar Burst Fracture

Thoracolumbar burst fractures occur when a vertebral body in the thoracic-lumbar junction (typically T11–L2) is severely compressed, resulting in fragmentation and retropulsion of bone into the spinal canal. These injuries often result from high-energy axial loading and may involve neurological compromise.

• High-energy trauma: fall from height, motor vehicle accident
• Axial compression with or without flexion/rotation
• Most commonly at the thoracolumbar junction due to biomechanical transition from the rigid thoracic to the mobile lumbar spine

• Sudden, severe localized back pain
• Possible neurological deficits:
  • Paraparesis, paresthesias, bladder or bowel dysfunction
• Point tenderness and muscle spasm
• Pain exacerbated by movement or upright posture

• X-ray (AP/lateral):
  • Loss of vertebral body height
  • Kyphotic deformity
• CT scan:
  • Gold standard for bony architecture
  • Evaluates spinal canal compromise and retropulsed fragments
• MRI:
  • Assesses spinal cord compression
  • Integrity of the posterior ligamentous complex (PLC)
  • Detects hematoma or edema

• AO Spine Classification:
  • AOSpine thoracolumbar spine injury classification system Subtype A3: Incomplete burst
  • AOSpine thoracolumbar spine injury classification system Subtype A4: Complete burst
• Load Sharing Classification (McCormack):
  • Grades comminution, apposition, and kyphosis
  • Helps guide need for anterior support

Thoracolumbar Burst Fracture Treatment