Thoracolumbar Spine Fractures | Spine Specialist

An Overview of Thoracolumbar Spine Fractures

The thoraco-lumbar region is an area that has the greatest incidence of fracture of any part of the spine. The fractures can be simple, such as transverse process fractures or much more complex such as fracture dislocations. Depending upon involvement of the nerves and the stability of the fractures, thoracolumbar spine fractures can be treated sometimes with a brace and sometimes with surgery.

The anatomy must be understood to know what can happen in this area. The spinal cord ends behind the first lumbar vertebra. The nerves that descend down the canal below this are called the cauda equina (horse’s tail in Latin and yes, combined together, they do look like a horse’s tail). Since compression of the spinal cord is more serious than compression of the nerve roots, fractures that cause canal compression are more serious in the upper part of the spine than in the lower spine.

If there is nerve or cord injury in a thoracolumbar spine fracture-generally surgery is recommended. Surgery gives the best chance to protect the remaining nerves and also gives the injured nerves the best chance to heal.

If there is no nerve or cord injury, then surgery may or may not be required. The most important facts to consider to avoid surgery are; is the spine stable in a brace, will it heal without a significant instability, is there the chance of pain if it heals in the position of fracture and will a deformity cause further wear over time?

Small fractures such as transverse process fractures are very painful but not dangerous. A period in a brace or even corset will allow these to heal or at least not continue to be painful.

Compression fractures are as they sound-compression of the body of the vertebra. Most of the time, these are not dangerous and will heal in a brace within three months. The vertebra will never regain the height they lost from the fracture, but most will heal with stability and not cause significant future problems. The patient however may become a weatherman for a year as barometric pressure changes will cause some discomfort. It may be handy in the mountains to entertain your friends with predictions of the amount of snow fall that will occur.

Burst fractures are more unstable but still many can be treated in a brace. A burst fracture involves the entire body of the vertebra and small pieces of bone may be thrust into the spinal canal. If there is not significant compression in the canal, there is no nerve injury and the fracture appears stable (a discussion more advanced than will be included here), then it may very well be treated in a brace.

(Click to Enlarge Image) Lateral CT scan of the burst fracture of L5.

(Click to Enlarge Image) Axial (bottom-up) CT scan image of the burst fracture. The black arrow points to the fragment pressing into the spinal canal.

(Click to Enlarge Image) This is a post-operative film of the fracture fragments reduced and healed. The black arrow points to the fragments no longer obstructing the spinal canal.

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One of the most significant factors in treating thoracolumbar spine fractures is the amount of angulation that occurs with the break. Remember that the area between the thoracic spine and lumbar spine is normally straight (see anatomy section). Most fractures cause a forward curve to occur called a kyphosis. Depending upon the degree of the forward curve or kyphosis, surgery may be warranted.

This is because without surgery the new curve will be permanent. The spine has to compensate for this new curve and most surgeons believe that 25 degrees of angulation is the maximum that the spine can compensate. Some believe that anything over 20 degrees is too much. To compensate without surgery, the lower spine has to bend backwards more to make up for the greater forward bend of the upper spine. This bend can cause greater wear of the joints in back (the facets) and can cause pain just by malalignment.

Fixing the spine surgically uses rods and screws to straighten out the deformed section and a fusion of the section performed to keep the spine straight. Any bone in the canal that causes problems should be removed.

If a brace is used to treat thoracolumbar spine fractures, the brace must be worn at all times. You would not remove a cast of your broken leg to take a shower for fear that the fracture would displace (separate). The same considerations should be given to a back fracture. Most fractures heal within three months. Then, when out of the brace, a physical therapy program is normally instituted to regain lost muscle strength.

When the fracture is healed, weaning out of the brace can be done in a twice a day removal pattern. Simply take the brace off for one hour in the morning and one hour in the evening. When that one hour is comfortable out of the brace, increase the time out of the brace by one half to one hour intervals until you are out of the brace full time. Occasionally, with muscle fatigue, you may need to temporarily put the brace back on.

For more information on research, study and analysis surrounding thoracolumbar spine fractures, please contact Dr. Donald Corenman, spine specialist and back surgeon offering diagnostic and surgical second opinions to patients in the USA and around the world.

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Thoraco-Lumbar Spine Fractures

An Overview of Thoracolumbar Spine Fractures

Are you suffering from symptoms of a thoracolumbar spine fracture?

About the Author: Donald Corenman, MD, DC

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