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From the American Academy of Orthopaedic Surgeons

Fracture of the Thoracic and Lumbar Spine

Thoracolumbar Burst Fractures

by Alexander R. Vaccaro, MD; L. Erik Westerlund, MD; Scott D. Daffner, MD

The definition of a thoracolumbar burst fracture is dependent upon the choice of fracture classification used by the treating physician. The mechanism of a thoracolumbar burst fracture is primarily axial vertebral body compression with or without a flexion-loading moment. Treatment options consist of either operative or nonoperative management.

This article discusses the pathophysiology and clinical presentation of thoracolumbar burst fraction, as well as management considerations, including nonsurgical treatment with and without neurologic deficit and surgical treatment with and without neurologic deficit, and the selection of an appropriate surgical approach. Two surgical techniques are presented in detail, including posterior distraction/ligamentotaxis reduction and anterior decompression anterbody fusion. Video is available.

Keywords: vertebral fracture, incidence, mechanism of injury, etiology, classification, Denis classification, McAfee classification, Ferguson-Allen classification, AO classification, diagnosis, patient history, physical examination, imaging, radiography, CT, MRI, myelography, differential diagnosis, surgical treatment, surgical techniques, surgical approaches, anterior approach, posterior approach, combined approach, posterior distraction, ligamentotaxis reduction, anterior decompression, spinal interbody fusion, indications, contraindications, complications, outcomes, rehabilitation

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