Unstable thoracolumbar fractures, with emphasis on the burst fracture.

There is much controversy as to the appropriate treatment of unstable thoracolumbar fractures. If surgery is decided upon, this article suggests a plan to accomplish the reduction of the fracture and decompression of the neural elements. The fractures are divided into compression injuries, seat belt injuries, fracture-dislocations, and burst fractures. In each case the goal is to realign and stabilize the spine and allow adequate room for the spinal cord or the cauda equina. A burst fracture requires the most careful planning. Some decompression can be accomplished by distraction alone but impaction of the fragments posteriorly or removal of the fragments anteriorly may be required. The experience at the author's university has demonstrated that by using these techniques, the preoperative neurocanal compromise can be significantly improved over those series using posterior distraction alone. If canal compromise cannot be accomplished posteriorly, then anterior surgery is required.