NS11 POSTERIOR APPROACHES FOR THORACO‐LUMBAR FRACTURES

The controversies remain in the management of thoraco‐lumbar fractures. These include who should receive surgical intervention, what constitutes instability of the thoraco‐lumbar spine, should an anterior or posterior approach be used to stabilise thoraco‐lumbar spine fractures, what length of instrumentation should be used and should bracing be utilised? At the present time there is a paucity of level 1 evidence to support a best practice recommendation for the management of thoraco‐lumbar spine trauma. Various classification systems have been introduced over the last 30–40 years to assist in the decision making process. These include the Holdsworth classification in 1970, the Dennis classification in 1983 and the Magerl AO classification in 1994. Very recently the thoraco‐lumbar injury classification and severity score has been introduced to try and further assist in the decision making on surgical intervention. The Burwood Spinal Injuries Service has also utilised the double ring concept of spinal instability in decision making. Various fracture patterns including burst fractures, flexion/distraction injuries and complex fracture dislocations, the indications for surgical intervention and the posterior approach to stabilising these fractures will be presented. A short segment posterior fixation with or without fusion for burst fractures and flexion/distraction injuries is recommended. Complex fracture dislocations and neurologically complete patients frequently require longer fixation with short or long fusion depending on fracture comminution and inherent stability. Recent developments with the use of image guided surgery, bone morphogenic protein and the potential for spinal cord regeneration are adding to our ability to deal surgically with thoraco‐lumbar spine trauma.