Describe Thoracolumbar Burst Fracture in detail.

Definition

A burst fracture is a compression fracture in which an axial load fails both the anterior and middle columns of the vertebra, so that bone is retropulsed into the spinal canal. It typically occurs at the thoracolumbar junction after a fall from height or an RTA, and — unlike a simple wedge compression — carries a risk of neurological injury.

Clinical Features & Investigations

Back pain, a palpable tender step, and a variable neurological deficit (from intact to conus/cauda involvement). Perform a full neurological and sacral examination. CT demonstrates the middle-column failure and canal compromise (retropulsed fragment); MRI is added for a deficit or to assess the posterior ligamentous complex and cord.

Management

A neurologically intact, stable burst fracture (acceptable kyphosis and canal compromise, intact posterior ligamentous complex) can be managed conservatively in a TLSO brace with early mobilisation and follow-up imaging. A fracture with a neurological deficit, significant canal compromise, progressive kyphosis or posterior ligamentous injury requires surgical decompression and instrumented stabilisation (posterior pedicle screws ± anterior decompression).

Assessing Stability & Complications

Decision-making is aided by scores such as the Load-Sharing classification (degree of comminution) and the TLICS score, which combine the fracture morphology, the integrity of the posterior ligamentous complex and the neurological status to guide operative versus non-operative treatment. Complications include a neurological deficit (conus or cauda), progressive kyphotic deformity and chronic pain from an inadequately stabilised fracture, and the general risks of surgery and prolonged recumbency.

Follow-up & Outcome

Whichever route is chosen, patients are followed with serial imaging to detect progressive kyphosis or late instability, and with repeated neurological examination. Most neurologically intact stable burst fractures do well with bracing; operative stabilisation reliably restores alignment in unstable injuries but carries surgical risks. Long-term back pain and stiffness are the commonest residual complaints.

Posterior ligamentous complex integrity determines stability.

• Axial load fails anterior + middle columns with retropulsion into the canal.
• Thoracolumbar junction; risk of neurological injury (unlike a simple wedge).
• CT shows middle-column failure/canal compromise; MRI for deficit/ligament/cord.
• Intact & stable → brace; deficit/unstable/canal compromise → decompress + fuse.