Thoracolumbar Fracture Dislocations Without Spinal Cord Injury: Classification and Principles of Management

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Thoracic and lumbar fracture dislocations (TLFD) are high-velocity injuries and frequently result in gross neurological deficit. Very rarely, such patients present with intact neurology. Pathomechanics of injury, radiological assessment, surgical techniques, and principles of fixation in such challenging situations have not been described previously. METHODS: Retrospective review of 36 patients of TLFD without cord injury was performed for demographics, clinical and radiological data, and management. The injuries were classified based on the direction of translation into 4 types: coronal translation (type 1), sagittal translation (type 2), combined translation—antero (type 3a), and combined translation—retro (type 3b). The injuries were managed by meticulous unilateral exposure and temporary fixation, decompression, gradual reduction of dislocation, and long segment fixation. RESULTS: In 36 patients, the injuries were classified as type 1 (n = 9), type 2 (n = 10), type 3a (n = 14), and type 3b (n = 3). Imaging/intraoperative observation showed varying degrees of disintegrity of disc, facet joints, and posterior ligamentous complex in the 4 different injury types. Patients with the different injury types also needed individualistic surgical approaches to aid safe reduction of dislocation. Neurological assessment was performed using American Spinal Injury Association score (ASIA), and 16 patients had minimal neurological deficits (ASIA-D) and all were type 3 injury. The mean anteroposterior and lateral translation were corrected from 8.3 ± 3.4 to 1.7 ± 1.3 mm, and 4.7 ± 4.8 to 0.7 ± 0.8 mm respectively. CONCLUSION: This is the largest case series of TLFD without cord injury. Knowledge of the different injury types and principles of safe surgical reduction of the dislocation are important for the treating surgeon to ensure successful outcomes.