Thoracic Spine Fractures and Dislocations

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Thoracic spine fractures, especially those resulting from high energy, can be devastating, often resulting in permanent neurologic injury. Neurologic deficit is encountered in 10-25% of all spinal column injuries, irrespective of the level of injury. A deficit occurs in 15-20% of all thoracolumbar injuries.

In the event of a complete neurologic injury, very few patients regain any useful motor function. Concomitant neurologic injury with spine fractures also adversely affects long-term survival. The 10-year survival rate for people younger than 29 years is 86%. This percentage drops precipitously to 50% for patients older than 29 years.

Documented treatment of spine fractures dates back several thousands of years. Closed treatment and manipulation to correct the sustained deformity were typically used. In the early 20th century, most treatment consisted of immobilization in hyperextension.

Treatment of spine fractures did not begin to evolve from universally closed treatments to the surgical modalities that are in place today until the advent of current anesthesia and radiographic techniques. Internal fixation was first seen after World War II. Initially, it was in the form of spinous process plating. Harrington then introduced his posterior spinal instrumentation. From this, modern surgical techniques and instrumentation developed.

Although the spinal stability and alignment established with these newer techniques have dramatically improved, there has been relatively little growth in the ability to improve the neurologic deficits sustained in these injuries over the years of spine fracture management.

For patient education resources, see Vertebral Compression Fracture.

A thorough knowledge of thoracic spine anatomy is essential in the treatment of thoracic spine fractures. Twelve thoracic vertebrae exist. The normal thoracic spine has an inherent kyphotic curve ranging from 18° to 51°. The vertebral bodies are wedge-shaped, being larger posteriorly than anteriorly. The kyphosis of the thoracic spine results in a center of gravity anterior to the apical T7 vertebrae, resulting in compression anteriorly and tension posteriorly in the resting state.

Significantly less flexion capabilities exist in the thoracic spine relative to the cervical and lumbar spine. The C7-T1 articulation flexes approximately 9°, T1-6 flexes 4°, and T6-7 to T12-L1 gradually increases to 5-12°. Less lateral bending occurs within the thoracic spine as well. Lateral bending is approximately 6° per level for T1-10 and approximately 8° at the thoracolumbar junction.

Axial rotation is 8° from T1 to T8. This is largely due to the coronal orientation of the facets in the thoracic spine. The axial rotation of the lower thoracic spine and thoracolumbar junction is reduced to 2° below T10 because of the transition to facets that are more sagittally oriented than those seen in the lumbar spine.

The thoracolumbar junction is relatively susceptible to injury. Injuries in this region constitute 50% of all vertebral body fractures. The decrease in rib restraint is largely responsible for the susceptibility of this area to injury. Other factors include changes in stiffness in flexion and axial rotation and the changes in disk size and shape that occur at the transition between the thoracic and lumbar spine.

The terminal portion of the spinal cord, the conus medullaris, normally begins at the T11 level. It ends at the L1-2 disk space in males and slightly more proximally in females. The cauda equina emanates from this region and extends distally into the lumbosacral spine with each peripheral nerve root exiting at its corresponding neural foramen. The cauda equina is more resistant to injury and has greater potential for recovery than the spinal cord.

The diameter of the spinal canal is also of great significance in thoracic spine fractures. The canal diameter of the thoracic spine is narrower than that of the cervical and lumbar spine. At the T6 level, the long axis of the spinal canal is approximately 16 mm in diameter, whereas in the midcervical and midlumbar spine, the long axis is 23 mm and 26 mm, respectively.

These dimensions have ramifications regarding the smaller amount of space available before cord compression is sustained in the event of a thoracic spine fracture. In addition, the smaller diameter may make fixation techniques such as sublaminar wire fixation more difficult and, thus, a less desirable method of stabilization.

The orientation and shape of the pedicles in the thoracic spine are different from those of their lumbar counterparts and can often preclude pedicle fixation. The pedicle isthmus width is smaller in the thoracic spine than in the lumbar spine. The transverse angle is approximately 27° medial inclination from posterior to anterior in the proximal thoracic spine, decreasing to 1° at T11 and to –4° at T12.

The vast majority of spine fractures occur as a result of motor vehicle accidents (45%), falls (20%), sports (15%), acts of violence (15%), and miscellaneous activities (5%). The percentage secondary to acts of violence is higher in urban areas. The male-to-female ratio is roughly 4:1. For mechanisms of injury, see Presentation.

The results are favorable for correction of deformity, maintenance of reduction, healing, and fusion rates. Overall clinical outcome is generally good, depending on the patient’s final neurologic function. Return of neurologic function, however, is variable, with little significant recovery seen in complete injuries irrespective of treatment.

Singh R, McD Taylor D, D’Souza D, Gorelik A, Page P, Phal P. Injuries significantly associated with thoracic spine fractures: a case-control study. Emerg Med Australas. 2009 Oct. 21 (5):419-23. [Medline].

Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 5th ed. Philadelphia: Elsevier Saunders; 2015. Vol 1: 911-80.

Chapman MW, Szabo RM, Vince KG, et al, eds. Chapman’s Orthopaedic Surgery. Philadelphia: Lippincott Williams & Wilkins; 2001. 3719-44.

Frymoyer JW, Ducker TB, Hadler NM, Kostuik JP, eds. The Adult Spine: Principles and Practice. 2nd ed. Philadelphia: Lippincott-Raven; 1991. 1269-324.

Aebi M. Classification of thoracolumbar fractures and dislocations. Eur Spine J. 2010 Mar. 19 Suppl 1:S2-7. [Medline]. [Full Text].

Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am. 1970 Dec. 52(8):1534-51. [Medline].

Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983 Nov-Dec. 8 (8):817-31. [Medline].

Browner BD, Jupiter JB, Krettek C. Thoracolumbar Fractures. Skeletal Trauma: Basic Science, Management, and Reconstruction. 5th ed. Philadelphia, PA: Elsevier; 2014 Dec 09. 803-812, 911-979.

Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011 Nov. 34 (6):535-46. [Medline].

Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. J Am Acad Orthop Surg. 2009 Dec. 17 (12):756-65. [Medline].

Moskowitz E, Schroeppel T. Brown-Sequard syndrome. Trauma Surg Acute Care Open. 2018. 3 (1):e000169. [Medline].

Kunam VK, Velayudhan V, Chaudhry ZA, Bobinski M, Smoker WRK, Reede DL. Incomplete Cord Syndromes: Clinical and Imaging Review. Radiographics. 2018 Jul-Aug. 38 (4):1201-1222. [Medline].

Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005 Oct 15. 30 (20):2325-33. [Medline].

Patel AA, Vaccaro AR. Thoracolumbar spine trauma classification. J Am Acad Orthop Surg. 2010 Feb. 18 (2):63-71. [Medline].

Nelson DW, Martin MJ, Martin ND, Beekley A. Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma. J Trauma Acute Care Surg. 2013 Jul. 75 (1):135-9. [Medline].

Emohare O, Cagan A, Morgan R, Davis R, Asis M, Switzer J, et al. The use of computed tomography attenuation to evaluate osteoporosis following acute fractures of the thoracic and lumbar vertebra. Geriatr Orthop Surg Rehabil. 2014 Jun. 5(2):50-5. [Medline]. [Full Text].

Smith MW, Reed JD, Facco R, Hlaing T, McGee A, Hicks BM, et al. The reliability of nonreconstructed computerized tomographic scans of the abdomen and pelvis in detecting thoracolumbar spine injuries in blunt trauma patients with altered mental status. J Bone Joint Surg Am. 2009 Oct. 91(10):2342-9. [Medline].

Imran JB, Madni TD, Pruitt JH, Cornelius C, Subramanian M, Clark AT, et al. Can CT imaging of the chest, abdomen, and pelvis identify all vertebral injuries of the thoracolumbar spine without dedicated reformatting?. Am J Surg. 2018 Jul. 216 (1):52-55. [Medline].

Lee HM, Kim HS, Kim DJ, Suk KS, Park JO, Kim NH. Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures. Spine (Phila Pa 1976). 2000 Aug 15. 25 (16):2079-84. [Medline].

Tan LA, Kasliwal MK, Traynelis VC. Comparison of CT and MRI findings for cervical spine clearance in obtunded patients without high impact trauma. Clin Neurol Neurosurg. 2014 May. 120:23-6. [Medline].

[Guideline] Chi JH, Eichholz KM, Anderson PA, Arnold PM, Dailey AT, Dhall SS, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: Novel Surgical Strategies. Neurosurgery. 2018 Oct 8. [Medline]. [Full Text].

Fehlings MG, Tetreault LA, Wilson JR, Kwon BK, Burns AS, Martin AR, et al. A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury: Introduction, Rationale, and Scope. Global Spine J. 2017 Sep. 7 (3 Suppl):84S-94S. [Medline].

[Guideline] Fehlings MG, Tetreault LA, Wilson JR, Aarabi B, Anderson P, Arnold PM, et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery. Global Spine J. 2017 Sep. 7 (3 Suppl):195S-202S. [Medline].

Fehlings MG, Wilson JR, Harrop JS, Kwon BK, Tetreault LA, Arnold PM, et al. Efficacy and Safety of Methylprednisolone Sodium Succinate in Acute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017 Sep. 7 (3 Suppl):116S-137S. [Medline].

Arnold PM, Harrop JS, Merli G, Tetreault LG, Kwon BK, Casha S, et al. Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017 Sep. 7 (3 Suppl):138S-150S. [Medline].

[Guideline] Fehlings MG, Martin AR, Tetreault LA, Aarabi B, Anderson P, Arnold PM, et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction. Global Spine J. 2017 Sep. 7 (3 Suppl):221S-230S. [Medline].

Burns AS, Marino RJ, Kalsi-Ryan S, Middleton JW, Tetreault LA, Dettori JR, et al. Type and Timing of Rehabilitation Following Acute and Subacute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017 Sep. 7 (3 Suppl):175S-194S. [Medline].

Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012. 7 (2):e32037. [Medline].

Rechtine GR. Nonsurgical treatment of thoracic and lumbar fractures. Instr Course Lect. 1999. 48:413-6. [Medline].

Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976). 2001 May 1. 26 (9):1038-45. [Medline].

Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar “burst” fractures treated conservatively: a long-term follow-up. Spine (Phila Pa 1976). 1988 Jan. 13 (1):33-8. [Medline].

Moller A, Hasserius R, Redlund-Johnell I, Ohlin A, Karlsson MK. Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up. Spine J. 2007 Nov-Dec. 7 (6):701-7. [Medline].

Stadhouder A, Buskens E, Vergroesen DA, Fidler MW, de Nies F, Oner FC. Nonoperative treatment of thoracic and lumbar spine fractures: a prospective randomized study of different treatment options. J Orthop Trauma. 2009 Sep. 23(8):588-94. [Medline].

Soliman HM, Nguyen H, Pintar FA, Yoganandan N, Kurpad SN, Maiman DJ. 177 Largest series of mild-moderate motor vehicle accident-associated thoracolumbar compression fractures: prognosis and outcome. Neurosurgery. 2016 Aug 1. 63 (CN Suppl 1):170-1.

Anderson PA. Long-term results still favor nonoperative treatment of stable thoracolumbar burst fractures: commentary on an article by Kirkham B. Wood, MD, et al.: “Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective randomized study with follow-up at sixteen to twenty-two years”. J Bone Joint Surg Am. 2015 Jan 7. 97 (1):e4. [Medline].

Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A. Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?. Spine (Phila Pa 1976). 2001 Jan 15. 26 (2):213-7. [Medline].

Dendrinos GK, Halikias JG, Krallis PN, Asimakopoulos A. Factors influencing neurological recovery in burst thoracolumbar fractures. Acta Orthop Belg. 1995. 61(3):226-34. [Medline].

Farcy JP, Weidenbaum M, Glassman SD. Sagittal index in management of thoracolumbar burst fractures. Spine (Phila Pa 1976). 1990 Sep. 15 (9):958-65. [Medline].

Scholl BM, Theiss SM, Kirkpatrick JS. Short segment fixation of thoracolumbar burst fractures. Orthopedics. 2006 Aug. 29(8):703-8. [Medline].

Rajasekaran S. Thoracolumbar burst fractures without neurological deficit: the role for conservative treatment. Eur Spine J. 2010 Mar. 19 Suppl 1:S40-7. [Medline]. [Full Text].

Bracken MB, Collins WF, Freeman DF, Shepard MJ, Wagner FW, Silten RM, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984 Jan 6. 251 (1):45-52. [Medline].

Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990 May 17. 322 (20):1405-11. [Medline].

Bracken MB, Shepard MJ, Hellenbrand KG, Collins WF, Leo LS, Freeman DF, et al. Methylprednisolone and neurological function 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study. J Neurosurg. 1985 Nov. 63 (5):704-13. [Medline].

Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997 May 28. 277 (20):1597-604. [Medline].

Coleman WP, Benzel D, Cahill DW, Ducker T, Geisler F, Green B, et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord. 2000 Jun. 13 (3):185-99. [Medline].

Sayer FT, Kronvall E, Nilsson OG. Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured analysis of published literature. Spine J. 2006 May-Jun. 6 (3):335-43. [Medline].

Hall ED. The neuroprotective pharmacology of methylprednisolone. J Neurosurg. 1992 Jan. 76 (1):13-22. [Medline].

Delamarter RB, Coyle J. Acute management of spinal cord injury. J Am Acad Orthop Surg. 1999 May-Jun. 7 (3):166-75. [Medline].

Knop C, Fabian HF, Bastian L, Blauth M. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976). 2001 Jan 1. 26 (1):88-99. [Medline].

Zdeblick TA, Warden KE, Zou D, McAfee PC, Abitbol JJ. Anterior spinal fixators. A biomechanical in vitro study. Spine (Phila Pa 1976). 1993 Mar 15. 18 (4):513-7. [Medline].

Zhao XL, Zhao HB, Wang B, Zhu XS, Li LZ, Zhang CQ. Lower cervical spine injury treated with lateral mass plates and pedicle screws through posterior approach. Chin J Traumatol. 2005 Jun. 8(3):160-4. [Medline].

Sasso RC, Best NM, Reilly TM, McGuire RA Jr. Anterior-only stabilization of three-column thoracolumbar injuries. J Spinal Disord Tech. 2005 Feb. 18 Suppl:S7-14. [Medline].

Machino M, Yukawa Y, Ito K, Nakashima H, Kanbara S, Morita D, et al. “Transforaminal thoracic interbody fusion” in the management of lower thoracic spine fracture dislocations: technical note. J Spinal Disord Tech. 2013 Aug. 26 (6):E209-14. [Medline].

Pickett J, Blumenkopf B. Dural lacerations and thoracolumbar fractures. J Spinal Disord. 1989 Jun. 2(2):99-103. [Medline].

Phillips DL, Brick GW, Spengler DM. A comparison of Harrington rod fixation with and without segmental wires for unstable thoracolumbar injuries. J Spinal Disord. 1988. 1 (2):151-61. [Medline].

Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery. 2001 Apr. 48 (4):771-8; discussion 778-9. [Medline].

Bransford R, Bellabarba C, Thompson JH, Henley MB, Mirza SK, Chapman JR. The safety of fluoroscopically-assisted thoracic pedicle screw instrumentation for spine trauma. J Trauma. 2006 May. 60(5):1047-52. [Medline].

Ibrahim FM, Abd El-Rady Ael-R. Mono segmental fixation of selected types of thoracic and lumbar fractures; a prospective study. Int Orthop. 2016 Jun. 40 (6):1083-9. [Medline].

Ma LT, Gong Q, Li T, Song YM, Pei FX, Zhao XD, et al. Relationship between the angle of vertebral screws and spinal lateral angulation after fixation of thoracolumbar fractures via an anterior approach. Genet Mol Res. 2014 Oct 7. 13 (4):8135-46. [Medline].

Fischer S, Vogl TJ, Kresing M, Marzi I, Zangos S, Mack MG, et al. Minimally invasive screw fixation of fractures in the thoracic spine: CT-controlled pre-surgical guidewire implantation in routine clinical practice. Clin Radiol. 2016 Oct. 71 (10):997-1004. [Medline].

McCullen G, Vaccaro AR, Garfin SR. Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technnique. Orthop Clin North Am. 1998 Oct. 29(4):813-28. [Medline].

Parker JW, Lane JR, Karaikovic EE, Gaines RW. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976). 2000 May 1. 25 (9):1157-70. [Medline].

Phan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015 Aug. 135:85-92. [Medline].

Gu G, Zhang H, He S, Cai X, Gu X, Jia J, et al. Percutaneous Pedicle Screw Placement in the Lumbar Spine: A Comparison Study Between the Novel Guidance System and the Conventional Fluoroscopy Method. J Spinal Disord Tech. 2015 Nov. 28 (9):E522-7. [Medline].

Wilson JR, Tetreault LA, Kwon BK, Arnold PM, Mroz TE, Shaffrey C, et al. Timing of Decompression in Patients With Acute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017 Sep. 7 (3 Suppl):95S-115S. [Medline].

Ohana N, Sheinis D, Rath E, Sasson A, Atar D. Is there a need for lumbar orthosis in mild compression fractures of the thoracolumbar spine?: A retrospective study comparing the radiographic results between early ambulation with and without lumbar orthosis. J Spinal Disord. 2000 Aug. 13 (4):305-8. [Medline].

Ghobrial GM, Williams KA Jr, Arnold P, Fehlings M, Harrop JS. Iatrogenic neurologic deficit after lumbar spine surgery: A review. Clin Neurol Neurosurg. 2015 Dec. 139:76-80. [Medline].

Luszczyk MJ, Blaisdell GY, Wiater BP, Bellabarba C, Chapman JR, Agel JA, et al. Traumatic dural tears: what do we know and are they a problem?. Spine J. 2014 Jan. 14 (1):49-56. [Medline].

Brian J Page, MD Resident Physician, Department of Orthopedic Surgery, Scott & White Medical Center-Temple, Baylor Scott & White Health

Brian J Page, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Texas Medical Association

Disclosure: Nothing to disclose.

Zachary T Hubert, MD Resident Physician, Department of Orthopedic Surgery, Baylor Scott & White Healthcare, Texas A&M University College of Medicine

Zachary T Hubert, MD is a member of the following medical societies: American Medical Association, Texas Medical Association

Disclosure: Received income in an amount equal to or greater than $250 from: Pylant Medical, Medical Device Business Services<br/>Monetary Support for Conference Attendance for: Stryker.

Mark Rahm, MD Chair and Associate Professor, Department of Orthopedic Surgery, Baylor Scott and White/Texas A&M Health Science Center College of Medicine, Scott and White Memorial Hospital

Mark Rahm, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, North American Spine Society, Texas Medical Association, Texas Orthopaedic Association

Disclosure: Received research grant from: institutional funds from K2M<br/>Received income in an amount equal to or greater than $250 from: Received royalty from SpineSmith.

Michael J Leahy, MD Staff Surgeon, Department of Orthopedic Surgery, Baylor Scott and White All Saints Medical Center, Harris Methodist Hospital of Fort Worth

Michael J Leahy, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, Texas Orthopaedic Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Kentucky Medical Association, North American Spine Society, Kentucky Orthopaedic Society, International Society for the Study of the Lumbar Spine, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India

Murali Poduval, MBBS, MS, DNB is a member of the following medical societies: Association of Medical Consultants of Mumbai, Bombay Orthopedic Society, Indian Orthopedic Association, Indian Society of Hip and Knee Surgeons

Disclosure: Nothing to disclose.

Lee H Riley III, MD Chief, Division of Orthopedic Spine Surgery, Associate Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

Thoracic Spine Fractures and Dislocations

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