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Abstract

Fractures of the thoracic spine account for only a small portion of sports-related spinal injuries. This is likely due to the limited mobility in this area in contrast to the cervical spine. Fractures tend to occur at the transition zones between the thoracic spine and the cervical and lumbar spine. These injuries often occur from compressive forces resulting in compression- or burst-type fractures, but injuries can also occur from distraction or rotational forces. Despite their overall rarity, injuries may be accompanied by neurological complications. Suspected thoracic injuries should be treated acutely with spinal precautions and referral for further evaluation. Treatment varies based on the type of fracture and associated neurologic injury. Return to play should be based on full recovery of motion, strength, and neurologic function and be determined on an individual basis as no specific guidelines exist.

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References

  1. Daniels AH, Sobel AD, Eberson CP. Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg. 2013;21(12):707–16.

    Article  PubMed  Google Scholar 

  2. Charles YP, Steib JP. Management of thoracolumbar spine fractures with neurologic disorder. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S31–40.

    Article  CAS  PubMed  Google Scholar 

  3. Gertzbein SD, Khoury D, Bullington A, St John TA, Larson AI. Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO Comprehensive classification. Am J Sports Med. 2012;40(8):1750–4.

    Article  PubMed  Google Scholar 

  4. Horton WC, Kraiwattanapong C, Akamaru T, Minamide A, Park JS, Park MS, Hutton WC. The role of the sternum, costosternal articulations, intervertebral disc, and facets in thoracic sagittal plane biomechanics: a comparison of three different sequences of surgical release. Spine. 2005;30(18):2014–23.

    Article  PubMed  Google Scholar 

  5. Watkins R 4th, Watkins R 3rd, Williams L, Ahlbrand S, Garcia R, Karamanian A, Sharp L, Vo C, Hedman T. Stability provided by the sternum and rib cage in the thoracic spine. Spine. 2005;30(11):1283–6.

    Article  PubMed  Google Scholar 

  6. Roberts DJ, Ouellet JF, Sutherland FR, Kirkpatrick AW, Lall RN, Ball CG. Severe street and mountain bicycling injuries in adults: a comparison of the incidence, risk factors and injury patterns over 14 years. Can J Surg. 2013;56(3):E32–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. AOSpine Injury Classification Systems. Spine J Orthop Trauma. 2018;32 Suppl 1:S145–60. AOSpine website. https://aospine.aofoundation.org/Structure/education/online-education/classifications/Pages/classifications.aspx. Accessed 7 July 2017.

  8. Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145–6.

    Article  PubMed  Google Scholar 

  9. Jones J. Burst fracture. Radiopaedia. https://radiopaedia.org/articles/burst-fracture. Accessed 4 Feb 2017.

  10. Posthuma de Boer J, van Wulfften Palthe AF, Stadhouder A, Bloemers FW. The clay shoveler’s fracture: a case report and review of the literature. J Emerg Med. 2016;51(3):292–7.

    Article  PubMed  Google Scholar 

  11. Murphy RF, Hedequist D. Excision of symptomatic spinous process nonunion in adolescent athletes. Am J Orthop (Belle Mead NJ). 2015;44(11):515–7.

    PubMed  Google Scholar 

  12. Olivier EC, Muller E, Janse van Rensburg DC. Clay-shoveler fracture in a paddler: a case report. Clin J Sport Med. 2016;26(3):e69–70.

    Article  PubMed  Google Scholar 

  13. Hetsroni I, Mann G, Dolev E, et al. Clay shoveler’s fracture in a volleyball player. Phys Sportsmed. 2005;33:38–42.

    Article  PubMed  Google Scholar 

  14. Kang D, Lee S. Multiple spinous process fractures of the thoracic vertebrae (clay-shoveler’s fracture) in a beginner golfer: a case report. Spine. 2009;34:E534–7.

    Article  PubMed  Google Scholar 

  15. Herrick RT. Clay shoveler’s fracture in power-lifting: a case report. Am J Sports Med. 1981;9:29–30.

    Article  CAS  PubMed  Google Scholar 

  16. Kaloostian PE, Kim JE, Calabresi PA, et al. Clay-shoveler’s fracture during indoor rock climbing. Orthopedics. 2013;36:381.

    Article  Google Scholar 

  17. National Center for Catastrophic Sports Injury Research. NCCSIR thirty-fifth annual report. National Center for catastrophic sports injury research: fall 1982-spring 2017. Chapel Hill: National Center for Sports Injury Research; 2018.

    Google Scholar 

  18. Dogan S, Safavi-Abbasi S, Theodore N, Chang SW, Horn EM, Mariwalla NR, Rekate HL, Sonntag VK. Thoracolumbar and sacral spinal injuries in children and adolescents: a review of 89 cases. J Neurosurg. 2007;106(6 Suppl):426–33.

    PubMed  Google Scholar 

  19. Carreon LY, Glassman SD, Campbell MJ. Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech. 2004;17(6):477–82.

    Article  PubMed  Google Scholar 

  20. Huang P, Anissipour A, McGee W, Lemark L. Return-to-play recommendations after cervical, thoracic, and lumbar spine injuries: a comprehensive review. Sports Health. 2016;8(1):19–25.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Franz T, Hasler RM, Benneker L, Zimmermann H, Siebenrock KA, Exadaktylos AK. Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts, Switzerland. Br J Sport Med. 2008;42(1):55–8.

    Article  CAS  Google Scholar 

  22. Boran S, Lenehan B, Street J, McCormack D, Poynton A. A 10-year review of sports-related spinal injuries. Ir J Med Sci. 2011;180(4):859–63.

    Article  CAS  PubMed  Google Scholar 

  23. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8(8):817–31.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  25. Patel AA, Vaccaro AR. Thoracolumbar spine trauma classification. J Am Acad Orthop Surg. 2010;18(2):63–71.

    Article  CAS  PubMed  Google Scholar 

  26. Wood KB, Khanna G, Vaccaro AR, Arnold PM, Harris MB, Mehbod AA. Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons. J Bone Joint Surg Am. 2005;87(7):1423–9.

    PubMed  Google Scholar 

  27. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC. 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;30(20):2325–33.

    Article  Google Scholar 

  28. Whang PG, Vaccaro AR, Poelstra KA, Patel AA, Anderson DG, Albert TJ, Hilibrand AS, Harrop JS, Sharan AD, Ratliff JK, Hurlbert RJ, Anderson P, Aarabi B, Sekhon LH, Gahr R, Carrino JA. The influence of fracture mechanism and morphology on the reliability and validity of two novel thoracolumbar injury classification systems. Spine. 2007;32(7):791–5.

    Article  PubMed  Google Scholar 

  29. Savage JW, Moore TA, Arnold PM, Thakur N, Hsu WK, Patel AA, McCarthy K, Schroeder GD, Vaccaro AR, Dimar JR, Anderson PA. The reliability and validity of the thoracolumbar injury classification system in pediatric spine trauma. Spine. 2015;40(18):E1014–8.

    Article  PubMed  Google Scholar 

  30. Vaccaro AR, Kreidl KO, Pan W, Cotler JM, Schweitzer ME. Usefulness of MRI in isolated upper cervical spine fractures in adults. J Spinal Disord. 1998;11(4):289–93.

    Article  CAS  PubMed  Google Scholar 

  31. Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: current perspectives. Open Access Emerg Med. 2017;26(9):57–62.

    Article  Google Scholar 

  32. Yamaguchi KT Jr, Myung KS, Alonso MA, Skaggs DL. Clay-shoveler’s fracture equivalent in children. Spine. 2012;37(26):E1672–5.

    Article  PubMed  Google Scholar 

  33. Ohana N, Sheinis D, Rath E, Sasson A, Atar D. Is there a need for lumbar orthosis in mild compression fractures of the thoracolumbar spine? A retrospective study comparing the radiographic results between early ambulation with and without lumbar orthosis. J Spinal Disord. 2000;13(4):305–8.

    Article  CAS  PubMed  Google Scholar 

  34. Urquhart JC, Alrehaili OA, Fisher CG, Fleming A, Rasoulinejad P, Gurr K, Bailey SI, Siddiqi F, Bailey CS. Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis. J Neurosurg Spine. 2017;27(1):42–7.

    Article  PubMed  Google Scholar 

  35. Singer G, Parzer S, Castellani C, Wegmann H, Lindbichler F, Till H, Eberl R. The influence of brace immobilization on the remodeling potential of thoracolumbar impaction fractures in children and adolescents. Eur Spine J. 2016;25(2):607–13.

    Article  PubMed  Google Scholar 

  36. Bailey CS, Urquhart JC, Dvorak MF, Nadeau M, Boyd MC, Thomas KC, Kwon BK, Gurr KR, Bailey SI, Fisher CG. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J. 2014;14(11):2557–64.

    Article  PubMed  Google Scholar 

  37. Vibert B, Garfin S. Management of traumatic thoracic compression and burst fractures. In: Kim D, Ludwig S, Vaccaro A, Change J, editors. Atlas of spine trauma: adult and pediatric, vol. 347. Philadelphia: Saunders; 2008.

    Google Scholar 

  38. Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, Oner FC. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine. 2004;29(7):803–14.

    Article  CAS  PubMed  Google Scholar 

  39. Rosenthal BD, Boody BS, Hsu WK. Return to play for athletes. Neurosurg Clin N Am. 2017;28(1):163–71.

    Article  PubMed  Google Scholar 

  40. Heneghan NR, Smith R, Tyros I, Falla D, Rushton A. Thoracic dysfunction in whiplash associated disorders: a systematic review. PLoS One. 2018;13(3):e0194235.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G, Carroll LJ, Ameis A, Ammendolia C, Brison R, Nordin M, Stupar M, Taylor-Vaisey A. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the bone and joint decade task force on neck pain and its associated disorders by the OPTIMa collaboration. Spine J. 2016;16(12):1598–630.

    Article  PubMed  Google Scholar 

  42. Khoury L, Chang E, Hill D, Shams S, Sim V, Panzo M, Vijmasi T, Cohn S. Management of thoracic and lumbar spine fractures: is MRI necessary in patients without neurological deficits? Am Surg. 2019;85(3):306–11.

    PubMed  Google Scholar 

  43. Wang S, Singh JM, Fehlings MG. Medical management of spinal cord injury. In: Winn HR, ed. Youmans and Winn neurological surgery. 7th ed. Philadelphia; 2017. p. 2493–504.e3.

    Google Scholar 

  44. Menzer H, Gill GK, Paterson A. Thoracic spine sports-related injuries. Curr Sports Med Rep. 2015;14(1):34–40.

    Article  PubMed  Google Scholar 

  45. Galeiras Vázquez R, Ferreiro Velasco ME, Mourelo Fariña M, Montoto Marqués A, Salvador de la Barrera S. Update on traumatic acute spinal cord injury. Part 1. Med Intensiva. 2017;41(4):237–47.

    Article  PubMed  Google Scholar 

  46. Silva NA, Sousa N, Reis RL, Salgado AJ. From basics to clinical: a comprehensive review on spinal cord injury. Prog Neurobiol. 2014;114:25–57.

    Article  PubMed  Google Scholar 

  47. Delamarter RB, Sherman J, Carr JB. Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression. J Bone Joint Surg Am. 1995;77(7):1042–9.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Matthew G. Zmurko .

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Zmurko, M.G. (2020). Thoracic Spine. In: Khodaee, M., Waterbrook, A., Gammons, M. (eds) Sports-related Fractures, Dislocations and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-36790-9_31

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  • DOI: https://doi.org/10.1007/978-3-030-36790-9_31

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