On the Management of Unstable Fractures of the Thoracolumbar Spine

Certain injuries of the thoracolumbar junction disrupt spinal stability by interrupting both the anterior and posterior supporting columns of the spine. Spinal cord injury occurs in these injuries as a result of insult from an anterior direction. Proposed management should include both posterior stabilization of the spine and anterior decompression of the cord, all accomplished, ideally, under one anesthetic. Five illustrative cases demonstrate the principles and outcomes of this approach.