ABSTRACT
Most injuries of the thoracolumbar spine occur in the transitional area – T11 to L2 – between the somewhat rigid upper and middle thoracic column and the flexible lumbar spine. The upper three-quarters of the thoracic segments are also protected to some extent by the rib cage, and fractures in this region tend to be mechanically stable. However, the spinal canal in that area is relatively narrow so cord damage is not uncommon and, when it does occur, it is usually complete. The spinal cord actually ends at L1 and below that level it is the lower nerve roots that are at risk. Segmental displacement may occur with various combinations of flexion, compression, rotation and shear. All three columns are disrupted and the spine is grossly unstable. These are the most dangerous injuries and are often associated with neurological damage to the lowermost part of the cord or the cauda equina. The injury most commonly occurs at the thoracolumbar junction.
