A 2004 narrative review from JAAOS synthesizing indications, classification systems, biomechanical principles, and surgical techniques for posterior instrumentation in thoracolumbar fractures. The review addresses when to operate, which construct to use, and how many levels to fuse across the full spectrum of fracture patterns.
25° kyphosis
50% vertebral height loss
40% canal compromise
When evaluating a thoracolumbar burst fracture, apply the three radiographic thresholds (>25° kyphosis, >50% height loss, >40% canal compromise) to flag instability in neurologically intact patients, then use the load-sharing classification to decide whether short-segment posterior fixation is safe or whether anterior column support is needed.
Remember: neurologic deficit changes the entire algorithm — decompression (direct or indirect) must accompany stabilization, and indirect ligamentotaxis is only reliably effective within the first 5 days.
A 2004 narrative review from JAAOS synthesizing indications, classification systems, biomechanical principles, and surgical techniques for posterior instrumentation in thoracolumbar fractures. The review addresses when to operate, which construct to use, and how many levels to fuse across the full spectrum of fracture patterns.
25° kyphosis
50% vertebral height loss
40% canal compromise
When evaluating a thoracolumbar burst fracture, apply the three radiographic thresholds (>25° kyphosis, >50% height loss, >40% canal compromise) to flag instability in neurologically intact patients, then use the load-sharing classification to decide whether short-segment posterior fixation is safe or whether anterior column support is needed.
Remember: neurologic deficit changes the entire algorithm — decompression (direct or indirect) must accompany stabilization, and indirect ligamentotaxis is only reliably effective within the first 5 days.