Fracture of the thoracic and lumbar spine.
Fractures of thoracic and lumbar spine are life-threatening.
Most of the circa six thousand serious injuries of the spine each year in Germany affect the thoracic and lumbar sections of the spine. In addition to the victims of traffic and accidents in the workplace, the followers of extreme sports and motorcyclists are the main contingent of spinal injuries, although this trend is decreasing. While lighter injuries are conservatively treated, i.e. without surgery, complex destruction of intervertebral discs and vertebrae in severe spinal cord injuries lead to an unstable situation where any straining or twisting of the spine may lead to dislocation of the vertebrae, and at worst, to injuries of the nerves or spinal cord. About 20% of the people affected by severe spinal injury suffer from paralysis - partial to complete paralysis. The goal of treatment is therefore the quickest possible restoration of stability, resilience and shape of the spine, which, as a rule, can only be achieved by operative measures in such unstable injuries.
Information from diagnostics to treatment and rehabilitation.
Information. Anatomy & injuries of thoracic & lumbar spine
Anatomy of the thoracic and lumbar spine.
The thoracic spine (BWS) includes 12, the lumbar spine (LWS) generally 5 vertebrae. In general therefore there is evidence of only 4 or 6 lumbar vertebrae in people because there are also anatomic variants. All vertebrae have a vertebral body at the front, from which two bony arches face towards the rear and enclose the spinal cord. In addition, each vertebra is pivotally attached to a rib on each side, which is why on the one hand, the mobility of the thoracic spine is somewhat limited, but on the other, part of the so-called rib cage gives extra protection and stability. For an upright person, the bulk of the load lies on the vertebral bodies at the front (~ 80%). The vertebral joints located at the rear take the remaining 20% percent. In the case of an injury, there is usually a rupture of the vertebral body, where sometimes the parts at the rear together with the back wall of the vertebral body are displaced into the spinal canal. The intervertebral discs play an important role in terms of a damping function and a uniform distribution of pressure.
What are typical injury patterns?
Different influences of forces, such as ones that occur during a fall, motorcycle or sports accident, result in different injury patterns. The classification of injuries of the thoracic and lumbar spine that is prevalent in Europe today was developed on the basis of the analysis of more than 2000 spinal cord injuries, and is now also the basis for diagnosis and therapy. This division, described as an AO classification, contains essentially three types of injuries.
Each of the three groups have additional subgroups that are only significant for detailed analysis and therapy planning.
Symptoms. Signs of fractures of thoracic & lumbar spine
Complaints caused by a fracture of thoracic & lumbar spine.
If, after a fall or accident, there is pain in the spine, an injury always should be considered. If a nerve deficit or even paralysis develops subsequently, it is likely a spinal injury. From a medical point of view, the existence of a spinal injury should always be assumed, until the contrary is proved by diagnosis.
In osteoporosis, a rupture of one or more vertebrae may happen even without a specific incident, and can cause considerable pain.
Causes. Development of spinal injuries
Thoracic spine injuries.
In contrast to the free-bearing neck and thoracic spine, the lumbar spine is a part of a bone-jointed entity of the sternum, bony thorax (thorax) and spine. The relative closeness of the spinal canal, that is, the channel within the spine that houses the spinal cord, and the lack of space for the spinal cord to move in cases of injury explains the frequency of neurological failures associated with external forces (traumas) to the thoracic spine. Injuries to the thoracic spine (such as a break) are not uncommon in the wake of a severe chest injury in falls or traffic accidents.
Injuries between the thoracic and lumbar spine.
The connection of the thoracic to the lumbar spine is the spinal section most commonly affected by injuries. More than 50% of all vertebral fractures affect the 12th thoracic and 1st lumbar vertebrae alone. The causes of a break are the specific biomechanical demands on this section of the spine. It is precisely in the transitional area from the somewhat more rigid thoracic spine to the more mobile lumbar spine, but also at the transition of the inward curvature of the lumbar spine (lordotic) to the thoracic outward curvature (kyphotic).