The thoracolumbar junction in the spine describes the joint that forms between the lowest thoracic vertebra and the highest lumbar vertebra. This is a transitional area in the spine, joining the rigid thoracic spine with the more mobile lumbar spine. The joint acts as a hinge between the two, making it particularly susceptible to injury.
One type of injury common to this spinal segment is the burst fracture. A burst fracture occurs when the entire vertebral body is fractured in all directions. This crushing of the vertebra causes bone fragments to spread out from it, both inward toward the spinal column and outward. Burst fractures are dangerous because they put your spinal cord at risk; bone fragments jutting into the spinal column could cause nerve impingement and even paralysis depending on the extent of impingement.
Burst fractures usually occur at the thoracolumbar junction due to trauma, such as a car accident or hard fall. Nerve impingement in this area often causes sharp, severe pain down the leg. The pain may wrap around to the groin region. Severe pain will also be experienced locally around the fracture.
Surgical Vs. Non-Surgical Treatment
Treatment for burst fractures is a topic of controversy. One thing is certain: Treatment is always needed, as this type of injury doesn't just heal on its own. Many, but not all, burst fractures require surgery. How to decide which fractures do and which don't require surgery is the subject of debate.
One main indicator for surgery is neurological deficit. If you have pain, weakness, numbness or loss of function along the nerve path, you have neurological symptoms. Injury to the thoracolumbar nerves can cause symptoms in the legs as well as loss of bladder and bowel control. If you don't have neurological symptoms, you may still require surgery.
The other treatment criterion to keep in mind is spinal stability. This has different definitions, but the most generally accepted definition of an unstable burst fracture is one that involves injury to the posterior portion of the vertebra and disc as well as the posterior ligament. Instability is generally considered grounds for surgery.
Spinal fusion is the surgery of choice for thoracolumbar fracture. Impinging bone fragments are removed and the unstable spinal segment is fused to prevent movement and nerve compression. After surgery, bracing and physical therapy are required. When surgery can be avoided, bracing for a period of 8-12 weeks followed by physical therapy is necessary.
The question of whether or not to receive surgery for burst fracture can be a hard one to answer. If you have no neurological symptoms but some instability, for example, which option is best? The review of the literature at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989512/ promotes the generally accepted opinion that, when instability is identified, early surgical treatment is best.
However, some in the medical field disagree with conventional wisdom. The definition of instability is vague, and a review of a number of control trials reveals that non-surgical treatment often has results on par with surgical treatment for burst fractures without neurological symptoms, with less financial expensive and risk of complications. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899715/ for an in-depth counterargument to surgery for unstable burst fractures.
Sometimes choosing what treatment to receive is hard, and this is the case with thoracolumbar burst fracture. While it is generally agreed that neurological symptoms indicate surgery, instability is questionable criteria for immediate invasive treatment. You will be best prepared to make a decision in your own case if you review the arguments for and against surgery and discuss your questions and concerns with your doctor.
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