Which of the following statements about burst fractures of the thoracolumbar spine are correct? (PGI Nov 2013)
|A||The injury most often occurs at the thoracolumbar junction.|
|B||The injury results from axial loading of the spine, often with concomitant flexion.|
|C||Anterior and middle column failure are always present in this injury.|
|D||Laminectomy provides satisfactory decompression.|
A. The injury most often occurs at the thoracolumbar junction.
B. The injury results from axial loading of the spine, often with concomitant flexion.
C. Anterior and middle column failure are always present in this injury.
i. Burst fractures result from axial compression of the spine, frequently associated with varying degrees of flexion.
ii. These injuries, which most often occur at the thoracolumbar junction, are characterized by circumferential expansion of the entire vertebra with failure of the anterior and middle spinal columns and in some cases, the posterior ones.
iii. Middle column failure in burst fractures results in retropulsion of the posterior superior portion of the vertebral body into the spinal canal.
iv. With marked retropulsion, compression of the dural tube occurs, often with associated neurologic deficit.
v. Surgical procedures designed to decompress and stabilize thoracolumbar burst fractures can be performed through anterior or posterior approaches.
vi. The major site of compression is anterior, and for this reason laminectomy does little to relieve compression of the spinal cord over an anterior lesion. Indeed, laminectomy further increases the instability of the spine.