Thoracolumbar Spine Injuries

McAfee et al Classification
Wedge-compression fracture
Stable burst fracture
Unstable burst fracture
Chance fracture
Flexion-distraction injury
Translational injuries

Mechanism of Injury
Generally from falls and motor vehicle accidents
Various combinations of flexion, extension, compression, torsion and shear forces

Examination
Log-roll is mandatory in all multiple traumatised patients
Localised tenderness/step/haematoma along the spinous processes indicate spinal injury
Examine for neurological deficits of the lower limbs and sacral plexus

X-rays
AP and lateral views of the thoracolumbar spine or lumbosacral spine as indicated
Oblique views are generally not indicated in the emergency setting

Management
Primary and secondary surveys to exclude associated injuries and resuscitate accordingly
Keep patient on strict spinal nursing
In cases of spinal cord injury, whether complete or incomplete, to start IV methyprednisolone first dose (30mg/kg BW over 30 minutes) at the A&E

Disposition
Admit to Department of Orthopaedic Surgery if isolated spine/other orthopaedic injuries
Admit to Department of Surgery if associated with more life-threatening cardiothoracic, abdominal or unstable head injuries