Thoracolumbar spine fracture-dislocation injury
Fracture-dislocation injury in thoracolumbar region is caused by various combinations of shear, torsion, distraction, flexion and extension forces and is a very unstable injury because three columns, including anterior, middle column and posterior column, are damaged. This is a high energy injury and 75% of it is accompanied with neurological injury 1).
The conservative treatment is not recommended for it because there are not only fractures but also various degrees of ligament and disc injury. It would be diagnosed if there is unilateral or bilateral facet fracture, subluxation or dislocation. If there is only subtle facet subluxation without neurological injury, it requires more attention for diagnosis. Lateral translation and anteroposterior translation of the spine may be observed by anteroposterior radiographs and lateral radiographs, respectively. CT is useful for the evaluation for bone injury and facet. MRI is used for determining the degree of the disc, ligament, and spinal canal injury.
Mostly, the reduction and the instrumented fusion using the posterior approach are preferred for this injury. Although the anterior approach is rarely used, if anterior column support is not enough or canal decompression is required after posterior surgery, the interbody fusion 2). using posterior approach or the anterior reconstruction can be performed 3).
Central cord syndrome may be associated with fracture-dislocation injury and compression fracture, especially in a congenitally narrowed spinal canal.