The need for multidisciplinary management of patients with upper thoracic spine fractures caused by high-velocity impact: a review of 32 surgically stabilised cases.

PURPOSE: To analyse the characteristics of patients who underwent surgery for fractures of the upper thoracic spine (T1-T6) in our institution. The thoracic spine is supported by the rib cage and associated ligaments; therefore, displacement and fracture of the upper thoracic spine in healthy young adults require a great force. The relatively narrow spinal canal around the spinal cord in this area could result in severe neurological deficit should fractures occur.

METHODS

The treatment course of 32 patients (26 men and 6 women) who underwent surgery for fractures of the upper thoracic spine between February 1995 and March 2001 was retrospectively reviewed. Parameters of injuries and treatment methods were evaluated.

RESULTS

Of the 32 patients, 29 were injured in traffic accidents (15 motorcycle and 14 vehicle), 2 in falls, and one by a heavy door falling on his back. 29 patients had spinal fractures at more than one level. 23 patients had complete, 7 had incomplete, and 2 had no neurological deficit. 30 patients required multiple modalities of radiological imaging (in addition to plain radiography) for diagnosis. 20 patients sustained other injuries apart from spinal fractures, 15 of them had associated chest injuries.

CONCLUSION

High-velocity fractures of the upper thoracic spine are injuries with devastating consequences, and can result in severe neurological deficit and concomitant injuries. These patients are best treated by a multidisciplinary approach.