Thoracic spine fractures and fracture dislocations often lead to neurological deficit, and associated injuries to morbidity and mortality.

An audit conducted between January 1999 and December 2000 evaluated the outcome of 63 patients with fractures and fracture dislocations of the thoracic spine. The mean age of patients, 41 of whom were male, was 30 years. In 45 patients the injury was sustained in a motor vehicle accident, and 23 patients had associated injuries. We used the Margel radiological classification. There were 37 fracture dislocations and 23 pure fractures. Twenty patients had a type-A injury (flexion), of which 19 were type AIII (burst). There were 40 patients with a type-B injury, 35 of which were type BI (flexion distraction), and three type BIII (flexion and axial loading). In three patients there was a type-C injury (rotational). There was total neurological deficit in 39 patients, 10 with type-A, 26 with type-B and three with type-C injuries. Fifteen patients had partial neurological deficit and nine were neurologically intact.

Posterior spinal fusion and bone graft was performed on 43 patients, anterior decompression and bone graft without instrumentation on seven, and combined anterior and posterior surgery on one. The remaining 12 were treated conservatively with orthoses. The neurological status of eight patients improved by a single grade following surgery and the neurological status of two following conservative treatment. Of the 54 patients with neurological deficit, 52 were wheelchair-bound. The poor neurological outcome was comparable to that in other studies.