Thoracolumbar Fractures

The spine is divided into several regions. The thoracolumbar spine comprises the vertebrae of the middle back (thoracic region, from T1 to T12) and the lower back (lumbar region, from L1 to L5). This area is particularly prone to fractures because it bears a large portion of the body’s weight and serves as a mechanical transition zone—that is, an area where physical stresses are exerted with maximum intensity.

The thoracolumbar junction, between T10 and L2, is the area most frequently affected.

Symptoms vary depending on the severity of the fracture and how it occurred. The most common signs are:

• Localized back or lower back pain, often acute, worsened by movement and relieved by rest
• Pain radiating to the abdomen, pelvis, or lower limbs when a nerve root is irritated
• Neurological symptoms in the most severe cases: muscle weakness, loss of sensation, or bladder and bowel control issues; these symptoms indicate compression of the spinal cord or nerves and may require urgent medical attention

In people with osteoporosis, multiple vertebral fractures may occur in succession if the bone disease is not treated concurrently.

Three main mechanisms explain the occurrence of these fractures:

High-energy trauma

A fall from a height, a car accident, a skiing accident, or a diving accident. The fracture results from a violent impact on a previously healthy spine.

Bone fragility associated with osteoporosis

Osteoporosis is a disease that reduces bone density and strength. The resulting fractures frequently occur after age 60, sometimes without any apparent trauma: a simple exertion, a sudden, awkward movement, or a minor fall may be enough.

Tumor-related bone fragility

Certain diseases, such as bone metastases or multiple myeloma, weaken the vertebrae, which can then fracture spontaneously or after minimal exertion.

• Advanced age (cumulative risk after age 60, especially in women)
• Known or untreated osteoporosis
• History of cancer involving the bones (metastases, multiple myeloma)
• Activities with a risk of severe trauma (mountain sports, motor sports)
• Smoking, which slows bone healing after a fracture

The diagnosis is based on a clinical examination and several imaging tests, selected depending on the specific circumstances:

Spinal X-ray

This provides an overall view of the spine’s alignment and allows for the measurement of deformity (kyphosis).

CT scan

Identify the type of fracture, assess the degree of vertebral compression, and check whether a bone fragment has displaced into the spinal canal (the passageway that protects the spinal cord).

MRI (magnetic resonance imaging)

Essential for assessing whether the fracture is recent or old, the condition of the ligaments, and any potential compression of the spinal cord or nerves.

Bone densitometry (DEXA)

Prescribe this test if osteoporosis is suspected to measure bone density and tailor long-term medical treatment.

Treatment is chosen based on the type of fracture, its stability, the patient’s neurological status, and overall health. There are two main options: conservative treatment (without surgery) and surgery.

Conservative Treatment

Many stable fractures without neurological involvement can heal without surgery. Treatment in these cases involves:

• Appropriate pain relievers to alleviate pain
• Early mobilization combined with physical therapy
• Regular clinical and radiological monitoring during the healing phase
• Treatment of underlying osteoporosis, if present

Surgical Treatment

When surgery is necessary (unstable fracture, intractable pain, neurological involvement, or risk of worsening), several techniques are available, ranging from percutaneous procedures (performed through the skin, without a large incision) to open surgery.

Kyphoplasty

A percutaneous technique indicated for compression fractures (primarily osteoporotic or tumor-related) . It involves inserting small expandable implants into the collapsed vertebra to straighten the vertebral body and restore the vertebra’s height, followed by the injection of surgical cement to stabilize the structure. The procedure is performed through two incisions measuring a few millimeters, under general anesthesia, and generally allows the patient to return home within 24 to 48 hours.

Percutaneous Pedicle Screw Fixation

For more complex fractures requiring true stabilization, screws can be placed through the skin and connected to one another by subcutaneous rods, forming a solid framework that keeps the spine aligned during healing. This technique preserves the back muscles, reduces blood loss, and shortens the length of hospital stay.

Wiltse Approach (mini-open)

When nerve decompression or a bone graft is necessary, the surgeon can access the spine by passing between the muscle fibers without cutting them. This approach better preserves the back muscles than a traditional incision.

Open Surgery

Reserved for the most complex fractures (fracture-dislocations, significant neurological deficits, extensive tumors) that necessarily require extensive decompression or major reconstruction of the spine.

Surgery on the thoracolumbar spine is now well established, but like any surgical procedure, it carries risks that patients should be aware of: wound infection (less common with percutaneous techniques), postoperative hematoma, thrombophlebitis (a blood clot in a vein), pulmonary embolism, or complications related to anesthesia.

Seek immediate medical attention if you experience:

• Sudden, severe back or lower back pain following a blow or a fall
• Persistent back pain, even without apparent trauma, especially if you are over 60
• Pain that radiates to the legs or abdomen

Seek emergency care if you experience weakness or paralysis in your lower limbs, loss of sensation in your legs, feet, or perineum, or problems with bladder or bowel control. These symptoms may indicate compression of the spinal cord or spinal nerves, a condition that requires urgent neurosurgical evaluation.

The Spine Surgery Department at Hôpital de La Tour treats all thoracolumbar fractures, from the simplest to the most complex cases.

The hospital offers all the diagnostic and follow-up tests required: conventional X-rays and EOS® weight-bearing X-rays, CT scans, MRIs, bone densitometry (DEXA), and, if necessary, SPECT-CT metabolic imaging.

The team primarily favors the least invasive approaches: SpineJack® kyphoplasty, short percutaneous fixations, and the Wiltse approach. These techniques result in minimal scarring, allow for mobilization as early as the day after surgery, and shorten the length of hospital stay. Procedures are guided by intraoperative 3D imaging (O-arm), neuronavigation for millimeter-precise implant placement, and continuous neurophysiological monitoring in cases of neurological risk. Clinical and radiological follow-up is scheduled at 6 weeks, 3 months, and 1 year. The hospital works in partnership with specialized rehabilitation centers for patients requiring rehabilitation after surgery.

Can a spinal fracture heal without surgery?

Yes, in many cases. Stable fractures without neurological involvement can be treated with rest, pain relievers, and physical therapy. Regular X-ray follow-ups help ensure that healing is progressing properly.

How do I know if my fracture is serious?

The severity depends on several factors: the type of fracture, the degree of compression, the presence of a bone fragment displaced into the spinal canal, and whether or not there are neurological signs. CT and MRI scans allow for a precise evaluation of these factors. Only a doctor can make this assessment.

Is kyphoplasty painful?

The procedure is performed under general anesthesia. After surgery, pain is generally significantly reduced within the first few hours. It is well controlled by modern pain medications, often without the need for morphine after the second or third day.

When will I be able to walk normally again after surgery?

In the vast majority of cases, weight-bearing and walking are permitted as early as the day after surgery. A return to normal activities occurs gradually, depending on the type of surgery performed and your surgeon’s recommendations.

What are the specific risks associated with kyphoplasty?

The main specific complication is cement leakage during injection—this is usually asymptomatic and has no clinical consequences. Other risks (nerve damage, dural tear) are very rare.

Does my osteoporosis increase the risk of re-fracture after surgery?

Yes. In patients with osteoporosis, a new vertebral fracture may occur if the bone disease is not treated concurrently. This is why osteoporosis treatment is an integral part of the overall management plan.

Do the screws and hardware need to be removed after the fracture has healed?

Not automatically. In some cases, removal of the hardware is considered 12 to 18 months after surgery, once healing has been confirmed, to restore optimal mobility. This decision is made in consultation with your surgeon during follow-up visits.

Do I need to wear a brace after surgery?

Wearing a brace or lumbar orthosis may be recommended depending on the type of fracture and the surgical technique used. Your surgeon will provide you with instructions tailored to your situation during your preoperative and postoperative appointments.