Evaluation of acute traumatic thoracolumbar spinal fractures; a case series

Background
Although diagnostics and treatment of thoracolumbar spinal fractures have evolved during the last few decades, it is unknown what classification system is the best and thereafter it is unknown how to optimally treat certain thoracolumbar spinal fractures. Therefore this study aims to describe the characteristics of acute thoracolumbar spinal fractures and the presence of associated injuries in adult patients presenting to the Emergency Department (ED).
Methods
Adult patients presenting to the ED of our level I trauma center between October 1st 2016 and August 31st 2021 with an acute thoracolumbar spinal fracture were analyzed retrospectively. The primary outcome was the comparison of the two main treatment modalities, operative versus non-operative treatment, in order to find differences in the characteristics of both patients and the fracture types. Secondary outcomes were the level of the fractured vertebrae and the classification of the fractures as well as the Injury Severity Scores and all other extra-spinal injuries. The fractures were classified using the AO Spine classification.
Results
A cohort of 578 patients with a total of 1152 fractures is analyzed specifically comparing operatively treated patients with non-operatively treated patients. 26% of the patients (n=153) was in need of surgical intervention. Half of the surgical interventions consists of posterior short segment fixation (PSSF), used in patients with a single spinal fracture. The majority of the fractures were stable (n=977) and located in the midthoracic and thoracolumbar junction. However, at least 15% of the fractures (n=175) were unstable. Injury distribution of patients presenting to the ED is diverse with 18,7% (n=108) patients having an ISS score higher than 15. Injuries to the extremities was seen in 22,8% of the patients and together with head, chest and abdominal injuries these were the most frequently found injuries, seen in 10-15% of the patients. Males presented to the ED with unstable fractures more often than women: 16,7% vs 10,5% respectively. Additionally, these fractures occurred in younger individuals: 16,7% vs 5,8%. More data is provided on comorbidities, complications and hospital stay.
Conclusions
More than a quarter of the patients with thoracolumbar spinal fractures are in need of surgical intervention. Half of them needs posterior long segment fixation, due to multiple spinal fractures often accompanied with life threatening injuries. Specifically for patients with type A3 and A4 fractures it is yet unknown how to best treat them. Prospective research designs focusing on unstable fractures including these burst fractures are needed.