Thoracolumbar Spine Trauma: Classification Systems, Management Strategies, and Current Clinical Challenges
Gede Odi Bayu Dharma Perkasa *
Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.
I. Gusti Lanang Ngurah Agung Artha Wiguna
Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Aims: To provide a focused review of thoracolumbar trauma, with emphasis on its biomechanical basis, injury patterns, diagnostic evaluation, classification systems, management strategies, and current clinical challenges.
Study Design: Narrative literature review.
Methodology: This review summarizes published literature on thoracolumbar trauma identified through searches of PubMed, Google Scholar, and other accessible academic sources. Relevant English-language studies involving human thoracolumbar spine injuries were selected based on their contribution to the understanding of epidemiology, biomechanics, clinical presentation, imaging, classification systems, treatment approaches, and rehabilitation. The included literature was synthesized thematically to provide a clinically relevant overview of thoracolumbar trauma and its management.
Results: The reviewed literature indicates that thoracolumbar trauma is a clinically important spinal injury because the thoracolumbar junction is a biomechanically vulnerable transition zone between the rigid thoracic spine and the mobile lumbar spine. Injury patterns range from stable compression fractures to unstable burst fractures, distraction injuries, and fracture-dislocations, with road traffic accidents and falls being the most common causes. Computed tomography and magnetic resonance imaging are essential for accurate assessment of fracture morphology, ligamentous injury, posterior ligamentous complex integrity, and neural compression. Classification systems such as the Denis three-column model, AO Spine classification, and Thoracolumbar Injury Classification and Severity Score (TLICS) are useful in evaluating instability and guiding treatment decisions. Stable injuries without neurological deficit are generally managed conservatively, whereas unstable fractures, posterior ligamentous complex disruption, progressive deformity, neural compression, and neurological deficit are the main indications for surgical intervention. Rehabilitation is important in both operative and non-operative care to support pain control, mobilization, functional recovery, and long-term quality of life. The literature also highlights ongoing challenges related to borderline cases, delayed diagnosis, limited resources, and real-world clinical decision-making.
Conclusion: Thoracolumbar trauma is a clinically significant and management-sensitive condition with substantial neurological and functional implications. Although classification systems are valuable in guiding treatment, management decisions must remain individualized according to instability, neurological status, ligamentous injury, and patient-specific factors. Early recognition, accurate assessment, timely intervention, and appropriate rehabilitation are essential to improve outcomes and reduce long-term complications.
Keywords: Thoracolumbar trauma, thoracolumbar junction, spinal injury classification, AO Spine classification, TLICS, spinal stability