Thoracolumbar dislocation

In these flexion-rotation injuries the posterior ligaments are completely torn. The articular processes are almost always fractured and the vertebral bodies may also be damaged. The thoracolumbar junction is the most common site and the majority suffer neurological damage in the lowest part of the cord or in the cauda equina. These injuries are always unstable.

Immediate treatment is pelvic traction. Further treatment depends upon whether there is paraplegia.

There are two options in injuries with paraplegia:

• Traction is continued for 6-8 weeks to achieve reduction and immobilisation. The patient is then allowed out of bed with a spinal brace. Whilst immobilised in traction these patients need considerable nursing care to avoid bed sores - involving frequent log-rolling.
• Immediate operation to reduce and internally fixate the fractures followed by early mobilisation and rehabilitation. The nursing of these patients is much easier than those treated conservatively.

In injuries without paraplegia, the spinal cord has so far escaped injury. If the facets are fractured reduction can usually be achieved by traction in extension. The spine is then immobilised with a plaster jacket or by internal fixation. If the facets are not fractured but locked open reduction and internal fixation is undertaken. A spinal brace is worn for at least three months.