Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques

Spinal injuries constitute about 3% of all injury cases and most of these injuries affect the thoracolumbar region, but thoracolumbar fracture-dislocations are much rarer. Dislocations (AO Type C injuries) of the thoracic and lumbar vertebrae, with or without associated fractures, happen due to very high energy trauma involving simultaneous, multidirectional, distractive and compressive forces across various spinal elements, which results in translational and rotational instability of the spinal column. Various reduction maneuvers have been described for thoracolumbar fracture-dislocations in the literature aiming to provide standardization in surgery for this situation. The aim of this review article is to systematically review the literature till date and describe various reduction maneuvers which help to achieve adequate sagittal and coronal balance as well as vertebral alignment with minimal soft tissue trauma. We searched the PubMed, the Cochrane Library (the most recent issue), Scopus, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Web of Science, International Clinical Trials Registry Platform (WHO), ClinicalTrials.gov and Google Scholar databases, besides other sources and general internet search. The strategy used in the search was briefly(''thoracolumbar'' OR ''dorsolumbar'') AND "dislocation" in PubMed. Similar searches were made in the other databases.Reference lists of the relevant papers were also examined and any further relevant studies, which were also included in the review. The initial search revealed 332 papers in Pubmed, out of which 302 were human studies. A similar search on Scopus revealed 528 documents and on WoS revealed 289 papers. Searching the Cochrane library revealed 9 trials, which were already revealed in Pubmed search results. All the references were imported into Endnote and we had 632 references after excluding duplicates and 126 papers were left in endnote after manual title screening and duplicate removal. Finally, 70 relevant papers were selected for consideration based on inclusion criteria, after excluding unrelated papers manually. We have summarised the published literature on the surgical management of thoraco-lumbar fracture dislocations and described the reduction maneuvers used in detail.