Guideline sources The following summarized guidelines for the evaluation of thoracolumbar spinal injuries are prepared by our editorial team based on guidelines from the Eastern Association for the Surgery of Trauma (EAST 2012). 1 2 2 2 2 3 Definition Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficits. 2 Epidemiology Injuries to the thoracolumbar spine are usually the result of high-energy blunt trauma. Thoracolumbar fractures occur principally due to motor vehicle injuries and falls from a height (65%), with the remainder of cases caused mainly by sports injuries and violence. 2 Pathophysiology The incidence of spinal injuries in North America is estimated at 64 per 100,000 person-years. 2 Disease course Though fractures of the thoracolumbar spine are common injuries, 50% of these are unstable and can result in significant disability, deformity and neurological deficits. 2 Prognosis and risk of recurrence Neurological status at admission is the most important factor related to patient's outcome. Thoracic (T4-T9) spinal cord injury has the least potential for neurologic improvement. Thoracolumbar (T10- https://web.pathway.md/diseases/rec66pc8e6rFH5F5U 1/3 6/24/23, 4:05 PM Thoracolumbar spinal injuries Pathway T12) and lumbar (conus) spinal cord injury have a greater rate of neurologic improvement. 3 Calculator Thoracolumbar Injury Classificat Guidelines 1. Diagnostic investigations Clinical examination: Consider excluding thoracolumbar spinal injury clinically (without radiographic imaging) in patients with blunt trauma in whom all of the following criteria are met: absence of thoracolumbar spinal pain absence of high-energy trauma mechanism absence of drug or alcohol intoxication normal mental status examination normal neurological and physical examination. C Indications for imaging: Obtain diagnostic imaging to rule out thoracolumbar spine in patients with blunt trauma in whom thoracolumbar spinal injury cannot be excluded clinically. B Consider diagnostic imaging of the entire spine in patients with blunt trauma with a known or suspected injury to the cervical spine, or any other region of the spine, given the high incidence of spinal injury at multiple levels in this patient population. C Spinal computed tomography: obtain multidetector CT of the spine with axial collimation as the test of choice to screen for and diagnose thoracolumbar spinal injuries when imaging is indicated, as CT is superior to radiographs in identifying thoracolumbar spine fractures. A Spinal magnetic resonance imaging: consider MRI in consultation with the spine service in patients with gross neurologic deficits or CT findings suggestive of neurologic involvement. C References 1. Sixta S, Moore FO, Ditillo MF et al. Screening for thoracolumbar spinal injuries in blunt trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73 5 Suppl 4 S326 32. Open 2. Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop. 2015 Jan-Feb;49 1 72 82. Open https://web.pathway.md/diseases/rec66pc8e6rFH5F5U 2/3 6/24/23, 4:05 PM Thoracolumbar spinal injuries Pathway 3. Harrop JS, Naroji S, Maltenfort MG et al. Neurologic improvement after thoracic, thoracolumbar, and lumbar spinal cord (conus medullaris) injuries. Spine Phila Pa 1976 . 2011 Jan 1;36 1 21 5. Open 4. Chi JH, Eichholz KM, Anderson PA 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. 2019 Jan 1;84 1 E59 E62. Open 5. Chi JH, Eichholz KM, Anderson PA 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. 2019 Jan 1;84 1 E59 E62. Open 6. Andrei Fernandes Joaquim, Dhiego Chaves de Almeida Bastos, H lio Henrique Jorge Torres et al. Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety. Global Spine J. 2016 Feb;6 1 80 5. Open 7. Alexander R Vaccaro, Ronald A Lehman Jr, R John Hurlbert 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 . 2005 Oct 15;30 20 2325 33. Open https://web.pathway.md/diseases/rec66pc8e6rFH5F5U 3/3