[Thoraco-lumbar spinal injuries--surgical indications and timing].

In thoracolumbar spine injuries, the indication for operative treatment and the time of operation are defined basically by the injury-pattern and by complicating neurological deficits. Immediate decompression is crucial in cases with worsening or secondarily occurring neurological involvements; incomplete paraplegia calls for undelayed decompression. Since accompanying neurological impairment usually represents high-grade instability of the spine, decompression includes fusion of the unstable motion segments. Both stability and shape of the spine determine the functional and subjective result within certain limits of tolerance. Therefore, clear indications for operative treatment exist for the following situations: no reduction possible in a closed manner, conservative fixation unpromising after closed reduction, restoration of stability uncertain in mainly ligamentous injuries. In addition, significant kyphotic and/or scoliotic deformities also require operative correction for satisfying results. An individual evaluation of both the benefit and the risk of all available therapeutic options is needed for every single case of only relative indication for operative measures. The accurate analysis of the injury-pattern determining stability and chances of healing as well as the knowledge of the efficiency of the planned therapy are prerequisites for a differentiated indication.