The Royal London and Queen's Romford Neurosurgery Society

Spine Workshop – Thoracolumbar fracture fixation

Fractures of the thoracic and lumbar region constitute a spectrum of injuries ranging from the simple undisplaced fractures to complex fracture dislocations.

Anatomically and functionally, the thoracic and lumbar spine can be divided into three regions – thoracic spine (T1-T10), thoracolumbar junction (T10-L2) and the lumbar spine (L3-L5).

The thoracic spine is functionally rigid due to coronally oriented facet joints, thin intervertebral discs and the ribcage. Thus, it requires huge amounts of energy to produce fractures and dislocations. The narrow spinal canal in this region predisposes to spinal cord damage resulting in a high incidence of neurological deficit.

The lumbar spine, on the other hand, is relatively flexible due to the thicker intervertebral discs, sagittal orientation of facet joints and the absence of the rib cage. The relatively lesser incidence of neurological injury in lumbar fractures can be attributed to the large size of the neural canal and the greater resilience of the cauda equina nerve roots.

The thoracolumbar junction (T10-L2) is uniquely positioned in between the rigid thoracic spine and the mobile lumbar spine. This transition from the less mobile thoracic spine with its associated ribs and sternum to the more dynamic lumbar spine subjects the thoracolumbar region to significant biomechanical stress. Hence, fractures of the thoracolumbar region are the most common injuries of the vertebral column (approximately 90%).

Pedicle screw fixation stabilises all three columns of the spine. Posterior short segment fixation can be performed by open or percutaneous method. Inserting additional pedicle screws at the level of the fracture site can help to provide better kyphosis correction and offers improved biomechanical stability.

Our workshop involved a series of lectures, discussions, practical demonstrations and hands-on simulated pedicle screw insertion techniques using saw bones and kit which was kindly sponsored by RTI.

Spinal Trauma Study Day Agenda

Hughlings Jackson Seminar Room, Level 2, The Royal London Hospital
Thursday 24th May 2018

10:30 Refreshments – Finsen Seminar Room
11:00 Introduction – Mr Pushpananthan
11:15 Techniques for thoracolumbar posterior instrumentation – Mr Bull
11:45 Open v Percutaneous instrumentation – Mr Pushpananthan
12:15 Implants: Hands-On with Sawbones – Mr Bull, Mr Pushpananthan, Mr Sedra & Mr Aftab
13:30 Close & Feedback

Further reading
  1. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies.  2015 Aug;135:85-92.

Mr Pushpananthan illustrates the role of intraoperative imaging to guide pedicle screw placement, demonstrates optimal screw trajectories to avoid complications, and describes strategies to reduce screw pull-out and improve the overall stability of the construct.

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