Skip to main content

Thoracic Spinal Stability: Decision Making

  • Chapter
  • First Online:
Spine Trauma
  • 2962 Accesses

Abstract

Injuries to the spine can have devastating and permanent consequences. The thoracic spine is unique due to the presence of the ribs, sternum, and associated articulations with the vertebral bodies. These structures create a relatively rigid structure that helps to prevent fractures and dislocations. Unfortunately, when these injuries do occur, they are frequently accompanied by significant neurologic deficits. Postinjury, spinal stability is evaluated via clinical exam and radiographic studies and via using various classification schemes. The definitive treatment of an injury depends on that patient’s structural stability and clinical symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. AB BDS, Winter RB et al (1977) Surgical stabilization of fracture and fracture-dislocations of the thoracic spine. Spine 2:185–196

    Article  Google Scholar 

  2. Anderson S, Biros MH, Reardon RF (1996) Delayed diagnosis of thoracolumbar fractures in multiple-trauma patients. Acad Emerg Med 3(9):832–839

    Article  PubMed  CAS  Google Scholar 

  3. Andriacchi T, Schultz A, Belytschko T, Galante J (1974) A model for studies of mechanical interactions between the human spine and rib cage. J Biomech 7(6):497–507

    Article  PubMed  CAS  Google Scholar 

  4. Bohlman HH (1985) Treatment of fractures and dislocations of the thoracic and lumbar spine. J Bone Joint Surg Am 67(1):165–169

    PubMed  CAS  Google Scholar 

  5. Bohlman H, Freehafer A, Dejak J (1985) The results of treatment of acute injuries of the upper thoracic spine with paralysis. J Bone Joint Surg Am 67(3):360–369

    PubMed  CAS  Google Scholar 

  6. Bracken M (1991) Treatment of acute spinal cord injury with methylprednisolone: results of a multicenter, randomized clinical trial. J Neurotrauma 8(suppl 1):S47–S50; discussion S51–S42

    Google Scholar 

  7. Bracken M (1993) Pharmacological treatment of acute spinal cord injury: current status and future projects. J Emerg Med 11(suppl 1):43–48

    PubMed  Google Scholar 

  8. Bracken M (2000) Methylprednisolone and spinal cord injury. J Neurosurg 93(1 Suppl):175–179

    PubMed  CAS  Google Scholar 

  9. Bracken M (2001) High dose methylprednisolone must be given for 24 or 48 hours after acute spinal cord injury. BMJ 322(7290):862–863

    Article  PubMed  CAS  Google Scholar 

  10. Bracken M (2001) Methylprednisolone and acute spinal cord injury: an update of the randomized evidence. Spine 26(24 suppl):S47–S54

    Article  PubMed  CAS  Google Scholar 

  11. Bracken M (2002) Methylprednisolone and spinal cord injury. J Neurosurg 96(1 suppl):140–141; author reply 142

    Google Scholar 

  12. Bracken M, Collins W, Freeman D et al (1984) Efficacy of methylprednisolone in acute spinal cord injury. JAMA 251(1):45–52

    Article  PubMed  CAS  Google Scholar 

  13. Bracken M, Shepard M, Collins W et al (1990) A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 322(20):1405–1411

    Article  PubMed  CAS  Google Scholar 

  14. Bracken M, Shepard M, Collins WJ et al (1992) Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg 76(1):23–31

    Article  PubMed  CAS  Google Scholar 

  15. Bracken M, Shepard M, Hellenbrand K et al (1985) Methylprednisolone and neurological function 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study. J Neurosurg 63(5):704–713

    Article  PubMed  CAS  Google Scholar 

  16. Bracken M, Shepard M, Holford T et al (1998) Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Results of the third National Acute Spinal Cord Injury randomized controlled trial. J Neurosurg 89(5):699–706

    Article  PubMed  CAS  Google Scholar 

  17. Day B, Kokan P (1977) Compression fractures of the thoracic and lumbar spine from compensable injuries. Clin Orthop Relat Res 124:173–176

    PubMed  Google Scholar 

  18. Denis F (1984) Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res 189:65–76

    PubMed  Google Scholar 

  19. Dickson JH, Harrington PR, Erwin WD (1978) Results of reduction and stabilization of the severely fractured thoracic and lumbar spine. J Bone Joint Surg Am 60(6):799–805

    PubMed  CAS  Google Scholar 

  20. Edwards CC, Levine AM (1986) Early rod-sleeve stabilization of the injured thoracic and lumbar spine. Orthop Clin North Am 17(1):121–145

    PubMed  CAS  Google Scholar 

  21. Esses SI (1988) The placement and treatment of thoracolumbar spine fractures. An algorithmic approach. Orthop Rev 17(6):571–584

    PubMed  CAS  Google Scholar 

  22. Ferguson RL, Allen BL Jr (1984) A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res 189:77–88

    PubMed  Google Scholar 

  23. Flesch JR, Leider LL, Erickson DL, Chou SN, Bradford DS (1977) Harrington instrumentation and spine fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. J Bone Joint Surg Am 59(2):143–153

    PubMed  CAS  Google Scholar 

  24. Gertzbein SD, Court-Brown CM (1989) Rationale for the management of flexion-distraction injuries of the thoracolumbar spine based on a new classification. J Spinal Disord 2(3):176–183

    Article  PubMed  CAS  Google Scholar 

  25. Harkonen M, Kataja M, Lepisto P, Paakkala T, Patiala H, Rokkanen P (1979) Fractures of the thoracic spine. Clinical and radiological results in 98 patients. Arch Orthop Trauma Surg 94(3):179–184

    Article  PubMed  CAS  Google Scholar 

  26. Harma M, Heliovaara M, Aromaa A, Knekt P (1986) Thoracic spine compression fractures in Finland. Clin Orthop Relat Res 205:188–194

    PubMed  Google Scholar 

  27. Holdsworth F (1970) Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 52(8):1534–1551

    PubMed  CAS  Google Scholar 

  28. Hurlbert R (2000) Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg 93(1 Suppl):1–7

    PubMed  CAS  Google Scholar 

  29. Jacobs RR, Asher MA, Snider RK (1980) Thoracolumbar spinal injuries. A comparative study of recumbent and operative treatment in 100 patients. Spine 5(5):463–477

    Article  PubMed  CAS  Google Scholar 

  30. Jacobs RR, Casey MP (1984) Surgical management of thoracolumbar spinal injuries. General principles and controversial considerations. Clin Orthop Relat Res 189:22–35

    PubMed  Google Scholar 

  31. Levine A, Bosse M, Edwards C (1988) Bilateral facet dislocations in the thoracolumbar spine. Spine 13(6):630–640

    PubMed  CAS  Google Scholar 

  32. Lucas M, Berg E (1997) Unilateral thoracic facet dislocation. Clin Orthop Relat Res 335:162–165

    PubMed  Google Scholar 

  33. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201

    Article  PubMed  CAS  Google Scholar 

  34. Maiman DJ, Pintar FA (1992) Anatomy and clinical biomechanics of the thoracic spine. Clin Neurosurg 38:296–324

    PubMed  CAS  Google Scholar 

  35. Maiman D, Pintar F (1992) Anatomy and clinical biomechanics of the thoracic spine. Clin Neurosurg 38:296–324

    PubMed  CAS  Google Scholar 

  36. McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 65(4):461–473

    PubMed  CAS  Google Scholar 

  37. McCormack T, Karaikovic E, Gaines R (1994) The load sharing classification of spine fractures. Spine 19(15):1741–1744

    Article  PubMed  CAS  Google Scholar 

  38. Meyer PR Jr (1986) Posterior stabilization of thoracic, lumbar, and sacral injuries. Instr Course Lect 35:401–419

    PubMed  Google Scholar 

  39. Scher AT (1983) Associated sternal and spinal fractures. Case reports. S Afr Med J 64(3):98–100

    PubMed  CAS  Google Scholar 

  40. Sutherland CJ, Miller F, Wang GJ (1983) Early progressive kyphosis following compression fractures. Two case reports from a series of “stable” thoracolumbar compression fractures. Clin Orthop Relat Res 173:216–220

    PubMed  Google Scholar 

  41. Vaccaro A, Lehman RJ, Hurlbert R et al (2005) A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 30(20):2325–2333

    Article  PubMed  Google Scholar 

  42. Vaccaro A, Zeiller S, Hulbert R et al (2005) The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech 18(3):209–215

    PubMed  Google Scholar 

  43. Weitzman G (1971) Treatment of stable thoracolumbar spine compression fractures by early ambulation. Clin Orthop Relat Res 76:116–122

    Article  PubMed  CAS  Google Scholar 

  44. White AA 3rd, Panjabi MM, Posner I, Edwards WT, Hayes WC (1981) Spinal stability: evaluation and treatment. Instr Course Lect 30:457–483

    PubMed  Google Scholar 

  45. White AA III, Panjabi MM, Thomas CL (1977) The clinical biomechanics of kyphotic deformities. Clin Orthop Relat Res 128:8–17

    PubMed  Google Scholar 

  46. Whitesides TE Jr (1977) Traumatic kyphosis of the thoracolumbar spine. Clin Orthop Relat Res 128:78–92

    PubMed  Google Scholar 

  47. Young MH (1973) Long-term consequences of stable fractures of the thoracic and lumbar vertebral bodies. J Bone Joint Surg Br 55(2):295–300

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nitin N. Bhatia .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Berlin Heidelberg

About this chapter

Cite this chapter

Smith, J., Bhatia, N.N. (2010). Thoracic Spinal Stability: Decision Making. In: Patel, V., Burger, E., Brown, C. (eds) Spine Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03694-1_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-03694-1_18

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-03693-4

  • Online ISBN: 978-3-642-03694-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics