Thoracolumbar and lumbosacral trauma

The evaluation and treatment of thoracolumbar and lumbosacral fractures have evolved over the past decade. Imaging standards in most trauma centers include the use of CT facilitated with MRI when necessary. Classification systems have been developed that afford both a common language for morphologic descriptions and treatment guidelines for management. Treatment guidelines are based on severity scores that take into account injury morphology and neurologic status. Most thoracolumbar and lumbosacral injuries can be managed nonsurgically; however, when surgical treatment is indicated, goals should include neurologic decompression when required, reduction, and spinal and/or pelvic stabilization. The timing of surgery is dependent on several variables, including patient comorbidities and polytrauma, but should be approached with urgency in the setting of an incomplete spinal cord injury.