title: Management of thoracolumbar spine fractures with neurologic disorder.
abstract: Thoracic and lumbar fractures represent approximately 50% of neurologic spinal trauma. They lead to paraplegia or cauda equina syndrome depending on the level injured. In the acute phase, the extension of spinal cord lesions should be limited by immediately treating secondary systemic injury factors. Quick recovery of hemodynamic stability, with mean arterial blood pressure>85 mm Hg, appears essential. There is no clinical evidence in favor of high-dose corticosteroid protocols. Their effect on neurologic recovery is unproven, whereas they lead to a higher rate of secondary septic and pulmonary complications. Incomplete deficits (ASIA B-D) require urgent surgery. There is no consensus with regard to complete paraplegia (ASIA A), but early surgery can enable neurologic recovery in some cases. The principle of surgical treatment is based on spinal cord decompression, instrumentation and fracture reduction. Early stabilization of the spine improves respiratory function and shortens the duration of mechanical ventilation and thus intensive care unit stay. Depending on the severity of associated lesions, early surgery within 48 hours is beneficial in polytrauma patients. Percutaneous instrumentation combined with mini-open posterior decompression stabilizes the spine, limiting approach-related morbidity.
authors.affiliation: Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France. Electronic address: yann.philippe.charles@chru-strasbourg.fr.
authors.forename: Y P
authors.initials: YP
authors.lastname: Charles
authors.affiliation: Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Steib
mesh_terms: D019299:Decompression, Surgical; D003952:Diagnostic Imaging; D005593:Fracture Fixation, Internal; D005938:Glucocorticoids; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D009460:Neurologic Examination; D018696:Neuroprotective Agents; D010264:Paraplegia / Q000209:etiology / Q000601:surgery*; D010808:Physical Examination; D013116:Spinal Cord / Q000098:blood supply; D016103:Spinal Fractures / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000601:surgery; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery
chemical_list: D005938:Glucocorticoids; D018696:Neuroprotective Agents
keywords: Hemodynamic management; Paraplegia; Spinal cord injury; Surgical treatment; Thoracolumbar fracture