Spine Injury: Thoracic
Basics
Description
Description
- The following forces account for most thoracic fractures and dislocations:
- Axial compression
- Flexion–rotation
- Shear
- Flexion–distraction
- Extension
- 3 anatomically distinct columns; if 2 of the 3 columns are disrupted, the spinal column is unstable:
- Posterior column: Posterior bony arch and interconnecting ligamentous structures
- Middle column: Posterior aspects of the vertebral bodies, posterior annulus fibrosis, and posterior longitudinal ligament
- Anterior column: Anterior longitudinal ligament, anterior annulus fibrosis, and anterior vertebral body
- Major vs. minor fractures:
- Minor:
- Isolated articular fracture
- Transverse process fracture
- Spinous process fracture
- Pars interarticularis fracture
- Major:
- Compression fracture
- Burst fracture
- Seat belt injury
- Fracture–dislocation
- Minor:
- Compression fracture (anterior or lateral flexion):
- Fracture of anterior portion of vertebral body with intact middle column
- May be posterior column disruption
- Type A: Fracture through both end plates
- Type B: Fracture through superior end plate
- Type C: Fracture through inferior end plate
- Type D: Both end plates intact
- Burst fracture (axial loading):
- Fracture through middle column of spine
- May have spreading of posterior elements and laminar fractures with possible retropulsion into the spinal canal and potential neurologic compromise
- Type A: Fracture through both end plates
- Type B: Fracture through superior end plate
- Type C: Fracture through inferior end plate
- Type D: Burst in middle column with rotational injury leading to subluxation
- Type E: Burst in middle column with asymmetric compression of anterior column
- Seat belt injury (flexion–distraction):
- Distraction of posterior and middle columns with anterior column intact
- Typically caused by lap belts used without shoulder harness
- Type A: Through bone
- Type B: Primarily ligamentous
- Type C: Disruption of bone through middle column
- Type D: Through ligaments and disc with no middle column fracture
- Fracture dislocations:
- Failure of all 3 columns following compression, tension, rotation, or shear forces
- Type A: Flexion–rotation; fall from height
- Type B: Shear-violent force across long axis of trunk
- Type C: Flexion–distraction; bilateral facet dislocation
Etiology
Etiology
- Thoracic spine is rigid owing to the support of the rib cage and the costovertebral articulations:
- The spinal canal is narrowest in the thoracic spine
- Traumatic thoracic spine fractures require enormous forces. Motor vehicle and motorcycle collisions, pedestrian's struck, and falls (particularly from height >10 ft) account for most fractures:
- A small percentage are caused by penetrating injuries (see “Spinal Cord Syndromes”)
- 50% of all spinal fractures and 40% of all spinal cord injuries occur at the thoracolumbar junction (T11–L2)
Pediatric Considerations
- Suspect nonaccidental trauma if thoracic spine injury without clear history of motor vehicle trauma
- Posterior rib fractures raise index of suspicion for abuse and require closer survey of thoracic spine and entire body for occult injury
Geriatric Considerations
Increased brittleness of bones in elderly (>65 yr) predispose to fractures with less severe mechanism, falls from lesser height
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Schaider, Jeffrey J., et al., editors. "Spine Injury: Thoracic." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307625/all/Spine_Injury:_Thoracic.
Spine Injury: Thoracic. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307625/all/Spine_Injury:_Thoracic. Accessed December 11, 2024.
Spine Injury: Thoracic. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307625/all/Spine_Injury:_Thoracic
Spine Injury: Thoracic [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 11]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307625/all/Spine_Injury:_Thoracic.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Spine Injury: Thoracic
ID - 307625
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307625/all/Spine_Injury:_Thoracic
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
ER -