Management of non-contiguous vertebral fractures

Non-contiguous vertebral fractures are not common. In 78 consecutive patients with acute thoracolumbar fractures, we found that 13 patients (16.7%) had non-contiguous spinal injuries. Five patients had a combination of cervical and thoracolumbar injuries and eight had a combination of thoracic and lumbar injuries. Four of the eight patients in the thoracic and lumbar group had posterior surgical stabilisation procedures. Two patients had instrumentation of all injured, non-contiguous vertebrae and healing occurred uneventfully, and two patients had instrumentation of only the major fracture and a progressive deformity occurred at the site of the minor fracture. We concluded that: patients with a spinal fracture should have radiographic evaluation of their entire spine to rule out non-contiguous fractures; if non-contiguous fractures are evident on standard radiographs, all levels of injury should be evaluated with computerised tomography; and all unstable or potentially unstable injuries should be reduced, stabilised, and fused.