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Spine
Diagnosis
Trauma
Vertebral Column, Discs, and Paraspinal Muscle
Thoracic and Lumbar Burst Fracture
Thoracic and Lumbar Burst Fracture
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Vertebral body fracture due to axial load, involving anterior & middle, ± posterior columns
                • Anterior column: Anterior longitudinal ligament (ALL), anterior 1/2 of vertebral body, & anterior anulus fibrosis
                • Middle column: Posterior longitudinal ligament (PLL), posterior 1/2 of vertebral body, & posterior anulus fibrosis
                • Posterior column: Neural arch, facet joint capsular ligaments, ligamentum flavum, inter- & supraspinous ligaments

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Chi JH et al: Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: novel surgical strategies. Neurosurgery. 84(1):E59-62, 2019
                                            2. Hoh DJ et al: Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: nonoperative care. Neurosurgery. 84(1):E46-9, 2019
                                            3. Zhang X et al: The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen. Spine J. 18(3):472-81, 2018
                                            4. Spiegl UJ et al: Incomplete burst fractures of the thoracolumbar spine: a review of literature. Eur Spine J. 26(12):3187-98, 2017
                                            5. Khurana B et al: Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics. 33(7):2031-46, 2013
                                            6. Lenarz CJ et al: Comparative reliability of 3 thoracolumbar fracture classification systems. J Spinal Disord Tech. 22(6):422-7, 2009
                                            7. Tisot RA et al: Laminar fractures as a severity marker in burst fractures of the thoracolumbar spine. J Orthop Surg (Hong Kong). 17(3):261-4, 2009
                                            8. Vaccaro AR et al: A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 30(20):2325-33, 2005
                                            9. Bensch FV et al: Spine fractures in falling accidents: analysis of multidetector CT findings. Eur Radiol. 14(4):618-24, 2004
                                            10. Haba H et al: Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures. J Neurosurg. 99(1 Suppl):20-6, 2003
                                            11. Leferink VJ et al: Burst fractures of the thoracolumbar spine: changes of the spinal canal during operative treatment and follow-up. Eur Spine J. 12(3):255-60, 2003
                                            12. Nguyen HV et al: Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech. 16(1):10-9, 2003
                                            13. Sheridan R et al: Reformatted visceral protocol helical computed tomographic scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. J Trauma. 55(4):665-9, 2003
                                            14. Wilcox RK et al: A dynamic study of thoracolumbar burst fractures. J Bone Joint Surg Am. 85-A(11):2184-9, 2003
                                            15. Wintermark M et al: Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology. 227(3):681-9, 2003
                                            16. Wood K et al: Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am. 85-A(5):773-81, 2003
                                            17. Parisini P et al: Treatment of spinal fractures in children and adolescents: long-term results in 44 patients. Spine. 27(18):1989-94, 2002
                                            18. Aydinli U et al: Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine. 26(18):E410-5, 2001
                                            19. Dai LY: Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthop. (382):119-23, 2001
                                            20. Kuklo TR et al: Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine. 26(1):61-5; discussion 66, 2001
                                            21. Lalonde F et al: An analysis of burst fractures of the spine in adolescents. Am J Orthop. 30(2):115-20, 2001
                                            22. McLain RF et al: Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J. 1(5):310-23, 2001
                                            23. Carl AL et al: Anterior dural laceration caused by thoracolumbar and lumbar burst fractures. J Spinal Disord. 13(5):399-403, 2000
                                            24. Denis F: The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 8(8):817-31, 1983
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Definitions

                                                          • Vertebral body fracture due to axial load, involving anterior & middle, ± posterior columns
                                                          • Anterior column: Anterior longitudinal ligament (ALL), anterior 1/2 of vertebral body, & anterior anulus fibrosis
                                                          • Middle column: Posterior longitudinal ligament (PLL), posterior 1/2 of vertebral body, & posterior anulus fibrosis
                                                          • Posterior column: Neural arch, facet joint capsular ligaments, ligamentum flavum, inter- & supraspinous ligaments

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Chi JH et al: Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: novel surgical strategies. Neurosurgery. 84(1):E59-62, 2019
                                                                                      2. Hoh DJ et al: Congress of neurological surgeons systematic review and evidence-based guidelines on the evaluation and treatment of patients with thoracolumbar spine trauma: nonoperative care. Neurosurgery. 84(1):E46-9, 2019
                                                                                      3. Zhang X et al: The mechanism of thoracolumbar burst fracture may be related to the basivertebral foramen. Spine J. 18(3):472-81, 2018
                                                                                      4. Spiegl UJ et al: Incomplete burst fractures of the thoracolumbar spine: a review of literature. Eur Spine J. 26(12):3187-98, 2017
                                                                                      5. Khurana B et al: Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics. 33(7):2031-46, 2013
                                                                                      6. Lenarz CJ et al: Comparative reliability of 3 thoracolumbar fracture classification systems. J Spinal Disord Tech. 22(6):422-7, 2009
                                                                                      7. Tisot RA et al: Laminar fractures as a severity marker in burst fractures of the thoracolumbar spine. J Orthop Surg (Hong Kong). 17(3):261-4, 2009
                                                                                      8. Vaccaro AR et al: A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 30(20):2325-33, 2005
                                                                                      9. Bensch FV et al: Spine fractures in falling accidents: analysis of multidetector CT findings. Eur Radiol. 14(4):618-24, 2004
                                                                                      10. Haba H et al: Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures. J Neurosurg. 99(1 Suppl):20-6, 2003
                                                                                      11. Leferink VJ et al: Burst fractures of the thoracolumbar spine: changes of the spinal canal during operative treatment and follow-up. Eur Spine J. 12(3):255-60, 2003
                                                                                      12. Nguyen HV et al: Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech. 16(1):10-9, 2003
                                                                                      13. Sheridan R et al: Reformatted visceral protocol helical computed tomographic scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. J Trauma. 55(4):665-9, 2003
                                                                                      14. Wilcox RK et al: A dynamic study of thoracolumbar burst fractures. J Bone Joint Surg Am. 85-A(11):2184-9, 2003
                                                                                      15. Wintermark M et al: Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology. 227(3):681-9, 2003
                                                                                      16. Wood K et al: Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am. 85-A(5):773-81, 2003
                                                                                      17. Parisini P et al: Treatment of spinal fractures in children and adolescents: long-term results in 44 patients. Spine. 27(18):1989-94, 2002
                                                                                      18. Aydinli U et al: Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine. 26(18):E410-5, 2001
                                                                                      19. Dai LY: Remodeling of the spinal canal after thoracolumbar burst fractures. Clin Orthop. (382):119-23, 2001
                                                                                      20. Kuklo TR et al: Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine. 26(1):61-5; discussion 66, 2001
                                                                                      21. Lalonde F et al: An analysis of burst fractures of the spine in adolescents. Am J Orthop. 30(2):115-20, 2001
                                                                                      22. McLain RF et al: Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up. Spine J. 1(5):310-23, 2001
                                                                                      23. Carl AL et al: Anterior dural laceration caused by thoracolumbar and lumbar burst fractures. J Spinal Disord. 13(5):399-403, 2000
                                                                                      24. Denis F: The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 8(8):817-31, 1983