Thoracic and lumbar spine injuries

Trauma to the thoracic and lumbar spine may be classified using the Magerl’s or Thoracolumbar Injury Classification and Severity Score (TLICS) classifications. Older thoracolumbar trauma classification systems include those of Holdsworth, which emphasizes the mechanism of injury; Whitesides, which defines the two-column concept being analogous to a construction crane; Punjabi and White, who developed stability scoring systems; and Denis with a mechanistic classification based on instability pertaining to three columns of the spine. Management may be conservative with analgesia and bracing or surgical with posterior, transthoracic, or circumferential spinal fusion. In this chapter the classification of these injuries and their management will be discussed. The techniques to insert pedicle screws and the role of minimally invasive techniques will be explained.