Flexion-distraction injury of the thoracolumbar spine

Flexion-distraction injury of the thoracolumbar spine results from a failure of both the posterior and middle columns under tension, and this injury is uncommon. Progressive kyphotic deformity frequently develops after conservative treatments. We report our 10 years' experience with the surgical treatment of flexion-distraction injuries. From January 1991 to December 2000, 30 flexion-distraction thoracolumbar spinal injuries were treated at our hospital. We included 23 patients in this study, and seven patients were excluded. The mean age of the patients was 37.2 years. Six were female and 17 were male. All patients received open reduction, posterior instrumentation, and posterior fusion at the level of injury. Post-operatively, patients were all placed in total contact orthoses for 3 months. Ambulation was allowed immediately after brace application.The mean follow-up period was 84.7 months follow-up. The final average follow-up kyphotic angulation was 5.4 degrees, which is an average improvement of 9.5 degrees. Post-operative back pain ratings indicated that result of surgery was mostly good, and the neurological evaluation was almost normal after long-term follow-up. A satisfactory reduction and good stabilisation with solid fusion was achieved in all cases, without any significant loss of reduction. Surgical treatment of reduction and stabilisation with posterior instrumentation and fusion is suggested in patients with flexion-distraction injury of the thoracolumbar spine.