Thoracolumbar injuries.

Thoracolumbar injuries represent an unique neurologic injury. In light of the potential for recovery in the roots of the cauda equina, an aggressive plan of management should be undertaken, to absolutely ensure an adequate decompression of the spinal canal and neural elements, but in addition to accomplish a simultaneous bony reduction and fusion of the injury site. Traditional laminectomy alone has minimal benefit in most of these cases, since compression is usually anterior and decompression is best achieved through a posterolateral or anterior transthoracic approach. The best avenue of decompression is dictated by a careful and complete preoperative radiographic evaluation, including polytomography and CT scanning. Utilization of this aggressive plan of management can then offer an optimum milieu for neurologic recovery and at the same time produce solid, pain-free bony healing with a minimum of spinal deformity.