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J Am Acad Orthop Surg, Vol 12, No 6, November/December 2004, 424-435.
© 2004 the American Academy of Orthopaedic Surgeons
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Posterior Instrumentation for Thoracolumbar Fractures

Mark R. Mikles, MD, Robert P. Stchur, MD and Gregory P. Graziano, MD

Dr. Mikles is Resident, Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI. Dr. Stchur is Resident, Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor. Dr. Graziano is Associate Professor, Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor.

Reprint requests: Dr. Graziano, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0328.

Thoracolumbar fractures are relatively common injuries. Numerous classification systems have been developed to characterize these fractures and their prognostic and therapeutic implications. Recent emphasis on short, rigid fixation has influenced surgical management. Most compression and stable burst fractures should be treated nonsurgically. Neurologically intact patients with unstable burst fractures that have >25° of kyphosis, >50% loss of vertebral height, or >40% canal compromise often can be treated with short, rigid posterior fusions. Patients with unstable burst fractures and neurologic deficits require direct or indirect decompression. Posterior stabilization can be effective with Chance fractures and flexion-distraction injuries that have marked kyphosis, and in translational or shear injuries. Advances in understanding both biomechanics and types of fixation have influenced the development of reliable systems that can effectively stabilize these fractures and permit early mobilization.






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