Surgical management of thoracolumbar spinal injuries. General principles and controversial considerations

Based on a review of the literature and experience with over 100 surgically treated thoracolumbar spinal injuries, the following information summarizes present knowledge of the subject. Reduction and internal fixation of the injured spine allows early mobilization of all patients, regardless of neurologic deficit, while protecting the neurologic structures from further injury and enhancing their recovery. The ability of the posterior ligamentous complex and the anterior bony column to withstand physiologic loads must be assessed by the history, physical examination, and radiography; then the injured structures should be protected from load or their function replaced by an appropriate surgical implant. Maximum neurologic recovery can be expected with prompt and complete decompression by reduction of the deformity, restoration of the spinal canal, and rigid internal fixation. The internal fixation system selected must provide compression for posterior injuries and distraction for anterior injuries, resist bending in combined injuries, and always restore normal spine shape. The rod-long, fuse-short technique provides the advantages of a more accurate reduction and a more secure fixation, and the minimum length of the fused region results in a more normal spine. The advantages of prompt and rigid but temporary internal fixation justify the risks both short- and long-term.