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Thoracolumbar spinal injuries

Definition
Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficits.
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Pathophysiology
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.
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Epidemiology
The incidence of spinal injuries in North America is estimated at 64 per 100,000 person-years.
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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.
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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-T12) and lumbar (conus) spinal cord injury have a greater rate of neurologic improvement.
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Key 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).
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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 areMET :
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
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