Burst fractures of the thoracolumbar spine (Part II): literature review


  • Vladimir A. Radchenko Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
  • Konstantin A. Popsuyshapka Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
  • Yuriy A. Babalyan Kharkiv Regional Clinical Hospital – Center of Emergency Medical Care and Disaster Medicine, Kharkiv, Ukraine
  • Sergii A. Teslenko Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine




thoracic spine, lumbar spine, burst fracture, diagnosis, classification, treatment


The modern view on the treatment of burst fractures in the lower thoracic and lumbar spine depends on the morphology of the damage and the neurological status, the general condition of the patient, and the surgeon’s preferences and skills. The treatment of A-type damages with vertebral body fragmentation up to 50% and the whole posterior support complex (by Margel classification), a conservative treatment method can be used, but with a predictable development of residual deformation of the spine. The use of surgical methods provides a good correction of spine deformity and gives a good functional result already in the early postoperative period.

The type AB injuries with vertebral body fragmentation up to 50%, with damage to the posterior support complex and posterior longitudinal ligament, with spinal stenosis up to 50%, without damage to the root of the arch (by Marerl classification) could be treated by a short posterior transpedicular fixation, preferably with 6 screws, without anterior reconstruction, but with a possible risk of loss of correction.

For damages of types A3.3, A3.1, and A3.2 with an LSS score over 7 without a severe neurological deficit or with it, a long 8-screw fixation is the most useful.

In the treatment of a complete uncomplicated burst fracture of the vertebral body of A 3.3 type, anterior decompression and anterior spondylodesis is the method of choice in the treatment of this pathology.

Reconstruction of the three columns of the spine from the posterior approach has advantages over the anteroposterior one only in patients with burst fractures with rotation (AS type) with complete or partial neurologic symptoms.

There is no unanimity regarding the use of different methods of fixation, which actuate to carry out our own research in this area.

Author Biographies

Vladimir A. Radchenko, Sytenko Institute of Spine and Joint Pathology, Kharkiv

Department of Instrumental and Minimally Invasive Spine Surgery

Konstantin A. Popsuyshapka, Sytenko Institute of Spine and Joint Pathology, Kharkiv

Department of Instrumental and Minimally Invasive Spine Surgery

Yuriy A. Babalyan, Kharkiv Regional Clinical Hospital – Center of Emergency Medical Care and Disaster Medicine, Kharkiv

Neurosurgical Department

Sergii A. Teslenko, Sytenko Institute of Spine and Joint Pathology, Kharkiv

Department of Instrumental and Minimally Invasive Spine Surgery


1. Alanay A, Yazici M, Acaroglu E, Turhan E, Cila A, Surat A. Course of nonsurgical management of burst fractures with intact posterior ligamentous complex: an MRI study. Spine (Phila Pa 1976). 2004 Nov 1;29(21):2425-31. [CrossRef] [PubMed]

2. Dai LY, Jiang LS, Jiang SD. Conservative treatment of thoracolumbar burst fractures: a long-term follow-up results with special reference to the load sharing classification. Spine (Phila Pa 1976). 2008 Nov 1;33(23):2536-44. [CrossRef] [PubMed]

3. Tezer M, Erturer RE, Ozturk C, Ozturk I, Kuzgun U. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop. 2005 Apr;29(2):78-82. Epub 2005 Feb 16. [PubMed] [PubMed Central]

4. 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. [CrossRef] [PubMed]

5. Radchenko VA, Korzh NA. Patologiya pozvonochnika: posobie dlya vrachey. Kiev: Zdorovya Ukrainy; 2013.

6. Harrington PR. The history and development of Harrington instrumentation. by Paul R. Harrington, 1973. Clin Orthop Relat Res. 1988 Feb;227:3-5. [CrossRef] [PubMed]

7. Ramikh EA. Evolyutsiya khirurgii povrezhdeniy pozvonochnika v komplekse vosstanovitel’nogo lecheniya. Khirurgiya pozvonochnika. 2004;(1):85-92. Russian. [eLIBRARY.RU]

8. Shkol’nikov LG, Selivanov VP. Opyt operativnogo lecheniya zakrytykh neoslozhnennykh kompressionnykh perelomov pozvonochnika s primeneniem fiksatora-styazhki. Ortopediya, travmatologiya i protezirovanie. 1966;(2):19-24. Russian.

9. Roy-Camille R, Roy-Camille M, Demeulenaere C. [Osteosynthesis of dorsal, lumbar, and lumbosacral spine with metallic plates screwed into vertebral pedicles and articular apophyses]. Presse Med. 1970 Jun;78(32):1447-8. French. [PubMed]

10. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201. [CrossRef] [PubMed]

11. Aebi M, Arlet V, Webb J. AoSpine Manual: Principles and Techniques, Clinical Applications. Thieme; 2007.

12. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L; AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013 Nov 1;38(23):2028-37. [CrossRef] [PubMed]

13. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1994 Aug 1;19(15):1741-4. [CrossRef] [PubMed]

14. Pham MH, Tuchman A, Chen TC, Acosta FL, Hsieh PC, Liu JC. Transpedicular Corpectomy and Cage Placement in the Treatment of Traumatic Lumbar Burst Fractures. Clin Spine Surg. 2016 Jul 14. [Epub ahead of print]. [CrossRef] [PubMed]

15. Zahra B, Jodoin A, Maurais G, Parent S, Mac-Thiong JM. Treatment of thoracolumbar burst fractures by means of anterior fusion and cage. J Spinal Disord Tech. 2012 Feb;25(1):30-7. [CrossRef] [PubMed]

16. Altay M, Ozkurt B, Aktekin CN, Ozturk AM, Dogan O, Tabak AY. Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures. Eur Spine J. 2007 Aug;16(8):1145-55. [CrossRef] [PubMed] [PubMed Central]

17. Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech. 2005 Dec;18(6):485-8. [CrossRef] [PubMed]

18. Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA Jr, Best NM. Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. J Spinal Disord Tech. 2006 Jun;19(4):242-8. [CrossRef] [PubMed]

19. Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech. 2009 Aug;22(6):417-21. [CrossRef] [PubMed]

20. Shi R, Liu H, Zhao X, Liu X, Gong Q, Li T, Liu L, Zeng J, Song Y. Anterior single segmental decompression and fixation for Denis B type thoracolumbar burst fracture with neurological deficiency: thirty-four cases with average twenty-six month follow-up. Spine (Phila Pa 1976). 2011 Apr 20;36(9):E598-605. [CrossRef] [PubMed]

21. 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. [CrossRef] [PubMed]

22. Gelb D, Ludwig S, Karp JE, Chung EH, Werner C, Kim T, Poelstra K. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech. 2010 Jul;23(5):293-301. [CrossRef] [PubMed]

23. Dai LY, Jiang LS, Jiang SD. Anterior-only stabilization using plating with bone structural autograft versus titanium mesh cages for two- or three-column thoracolumbar burst fractures: a prospective randomized study. Spine (Phila Pa 1976). 2009 Jun 15;34(14):1429-35. [CrossRef] [PubMed]

24. Haiyun Y, Rui G, Shucai D, Zhanhua J, Xiaolin Z, Xin L, Xue W, Gongyi L, Jiankun L. Three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976). 2010 Apr 15;35(8):E295-302. [CrossRef] [PubMed]



How to Cite

Radchenko, V. A., Popsuyshapka, K. A., Babalyan, Y. A., & Teslenko, S. A. (2018). Burst fractures of the thoracolumbar spine (Part II): literature review. Ukrainian Neurosurgical Journal, (1), 19–27. https://doi.org/10.25305/unj.113533



Review articles