Abstract
Dislocations of the thoracolumbar spine, which account for 11% of injuries in the T10 to L2 region, follow a high-energy, flexion-distraction force. In this region, there is a transition from a fixed kyphosis to a mobile lordosis, an absence of costotransverse ligaments and a change of facet alignment from a coronal to a sagittal plane.
In 1999, we treated 12 male and nine female patients with dislocations of the thoracolumbar spine. Their mean age was 30 years. Sixteen patients had been involved in motor vehicle collisions, four had fallen from a height and one had been assaulted with an iron bar. There were 14 Frankel grade-A injuries, one Frankel grade-C, two Frankel grade-D and four Frankel grade-E injuries. The site of injury was T12/L1 in 14 patients, L1/L2 in four, T11/T12 level in four and T10/T11 in one. Associated injuries included electrical burns and a fractured femur. None of the patients sustained visceral injuries. All patients were stabilised with transpedicular fixation. No disc sequestration was found.
Following surgery, one of the 14 Frankel grade-A patients improved to Frankel grade C but 13 made no neurological recovery. The four patients graded Frankel E did not deteriorate. The remaining three patients with partial neurological deficit made a complete recovery. Postoperative sepsis resolved in one patient following debridement and antibiotic therapy.
The thoracolumbar junction is anatomically and biomechanically predisposed to traumatic dislocation. The poor neurological outcome with dislocations at T11/T12 and T12/L1 may be attributed to cord injury, but injuries distal to this level have a better prognosis owing to cauda equina involvement.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
