Edited by Aditya Karhade and Brian Goh - 7/1/2021
Descriptors
Use the following descriptors to describe injury:
- Mechanism of injury?
- Typically thoracolumbar levels: T10 - L2
- Superior and inferior endplate involvement?
- Degree of comminution?
- Retropulsion, compression of thecal sac?
- Involvement of posterior ligamentous complex?
- Kyphosis?
Can use the AO Spine classification system to further describe fractures.
Workup
Radiographs:
Helpful to determine sagittal alignment and stability (with standing XR); however if high suspicion for gross instability do not order flex-ex or standing XRs until staffing with spine fellow.
Will need upright XRs for follow up
Other imaging:
CT if traumatic mechanism
Assess interspinous distances for indication of posterior column/PLC disruption
Request MRI if any concern for posterior ligamentous complex involvement or new neurologic deficit on exam
Labs: None unless preop
Other: None unless preop
Management
Need for acute intervention:
Neurologic deficit:
Decompression + fusion if new +/- progressive neurologic deficit
Instability:
Disruption of posterior ligamentous complex
Weight-bearing and range of motion:
If no neurologic deficit or instability: no bending, twisting, or lifting > 10 pounds until follow-up in clinic
If new neurologic deficit or instability: bed rest with logroll precautions until reviewed with spine staff
Type of immobilization: If no neurologic deficit and no operative intervention planned on index admission: thoracolumbar orthosis at attending discretion (no difference in outcomes)
Admission or discharge status: If isolated injury without neurologic deficit or instability, ED OBS status, PT, pain control, follow-up in spine clinic in 1-week
If isolated injury with neurologic deficit or instability, admit to ortho spine for decompression + fusion
If multisystem trauma, admit to trauma surgery (general surgery)
Anticoagulation: No anticoagulation
Antibiotics: None
Surgical Indications
Absolute:
Progressive neurologic deficit
Relative: TLICS score > 4
Not an indication: Back pain