A plea for judgment in management of thoracolumbar fractures and fracture-dislocations. A reassessment of surgical indications.

Until basic knowledge of fracture anatomy and stability includes experiments with comminuted anterior column injuries, posterior column injuries, and these injuries in combination with ligament and capsular injuries, and until the long-term implications of the long fusion in an otherwise healthy patient are fully known, clinicians making decisions about individual patients must assemble all the variables that bear on the patient's ability to heal and become fully functional again before making a decision about surgical stabilization of the thoracolumbar fracture. An assessment of plain roentgenograms, tomograms, and CAT scans and an understanding of the anatomy of the fracture site provide essential but insufficient data for clinical decisions about patients.