The Importance of Alignment in the Management of Thoracolumbar Trauma.

Abstract

Spinal injuries occur in 3% of all trauma patients, most commonly in males, and often due to high-velocity impact followed by abrupt deceleration. The most affected region following spinal trauma is the thoracolumbar junction due to the anterior center of gravity at T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus non-operative management of traumatic injuries at this site. However, the current classifications do not consider the segmental alignment of the spine - an aspect which has been shown to improve quality of life in non-traumatic post-operative spinal patients. Ignoring this aspect of thoracolumbar management often contributes to the development of post-traumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the injured vertebra's level, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to demonstrate the importance of segmental sagittal alignment and the vertebral level on patient outcomes.