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Thoracic and Lumbar Hyperextension Injury
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Thoracolumbar hyperextension injury (TLHI)
            • Synonyms

              • Extension-distraction injury; hyperextension-dislocation injury; lumberjack paraplegia

            IMAGING

            • General Features

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Tan T et al: Patients with ankylosing spondylitis suffering from AO Type B3 traumatic thoracolumbar fractures are associated with increased frailty and morbidity when compared with patients with diffuse idiopathic skeletal hyperostosis. J Spine Surg. 5(4):425-32, 2019
                              2. Lindtner RA et al: Fracture reduction by postoperative mobilisation for the treatment of hyperextension injuries of the thoracolumbar spine in patients with ankylosing spinal disorders. Arch Orthop Trauma Surg. 137(4):531-41, 2017
                              3. Rustagi T et al: Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes. J Orthop Trauma. 31 Suppl 4:S57-S74, 2017
                              4. Balling H et al: Hyperextension injuries of the thoracolumbar spine in diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976). 40(2):E61-7, 2015
                              5. Westerveld LA et al: Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 14(5):729-40, 2014
                              6. Reinhold M et al: AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J. 22(10):2184-201, 2013
                              7. Elgafy H et al: Three-column ligamentous extension injury of the thoracic spine: a case report and review of the literature. Spine (Phila Pa 1976). 32(25):E785-8, 2007
                              8. Smith IJ et al: Lower lumbar hyperextension fracture without paraplegia. J Spinal Disord Tech. 16(3):295-8, 2003
                              9. Mirza SK et al: Classifications of thoracic and lumbar fractures: rationale and supporting data. J Am Acad Orthop Surg. 10(5):364-77, 2002
                              10. Davis RE et al: Traumatic hyperextension/hyperflexion of the lumbar vertebrae with entrapment and strangulation of small bowel: case report. J Trauma. 49(5):958-9, 2000
                              11. Chiu WC et al: Entrapment and obstruction of the esophagus from thoracic spine hyperextension-dislocation injury. J Trauma. 46(5):959-61, 1999
                              12. Nabeshima Y et al: Extension injury of the thoracolumbar spine. Spine (Phila Pa 1976). 22(13):1522-5; discussion 1525-6, 1997
                              13. Ghavam C et al: Extension-distraction fracture of the first lumbar vertebra. Spine (Phila Pa 1976). 20(9):1080-3, 1995
                              14. Denis F et al: Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine (Phila Pa 1976). 17(2):156-61, 1992
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Clinical Issues

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Abbreviations

                                          • Thoracolumbar hyperextension injury (TLHI)
                                        • Synonyms

                                          • Extension-distraction injury; hyperextension-dislocation injury; lumberjack paraplegia

                                        IMAGING

                                        • General Features

                                          • MR Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • Staging, Grading, & Classification

                                                  CLINICAL ISSUES

                                                  • Demographics

                                                    • Natural History & Prognosis

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Tan T et al: Patients with ankylosing spondylitis suffering from AO Type B3 traumatic thoracolumbar fractures are associated with increased frailty and morbidity when compared with patients with diffuse idiopathic skeletal hyperostosis. J Spine Surg. 5(4):425-32, 2019
                                                          2. Lindtner RA et al: Fracture reduction by postoperative mobilisation for the treatment of hyperextension injuries of the thoracolumbar spine in patients with ankylosing spinal disorders. Arch Orthop Trauma Surg. 137(4):531-41, 2017
                                                          3. Rustagi T et al: Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes. J Orthop Trauma. 31 Suppl 4:S57-S74, 2017
                                                          4. Balling H et al: Hyperextension injuries of the thoracolumbar spine in diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976). 40(2):E61-7, 2015
                                                          5. Westerveld LA et al: Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 14(5):729-40, 2014
                                                          6. Reinhold M et al: AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J. 22(10):2184-201, 2013
                                                          7. Elgafy H et al: Three-column ligamentous extension injury of the thoracic spine: a case report and review of the literature. Spine (Phila Pa 1976). 32(25):E785-8, 2007
                                                          8. Smith IJ et al: Lower lumbar hyperextension fracture without paraplegia. J Spinal Disord Tech. 16(3):295-8, 2003
                                                          9. Mirza SK et al: Classifications of thoracic and lumbar fractures: rationale and supporting data. J Am Acad Orthop Surg. 10(5):364-77, 2002
                                                          10. Davis RE et al: Traumatic hyperextension/hyperflexion of the lumbar vertebrae with entrapment and strangulation of small bowel: case report. J Trauma. 49(5):958-9, 2000
                                                          11. Chiu WC et al: Entrapment and obstruction of the esophagus from thoracic spine hyperextension-dislocation injury. J Trauma. 46(5):959-61, 1999
                                                          12. Nabeshima Y et al: Extension injury of the thoracolumbar spine. Spine (Phila Pa 1976). 22(13):1522-5; discussion 1525-6, 1997
                                                          13. Ghavam C et al: Extension-distraction fracture of the first lumbar vertebra. Spine (Phila Pa 1976). 20(9):1080-3, 1995
                                                          14. Denis F et al: Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine (Phila Pa 1976). 17(2):156-61, 1992