Synopsis
Recognise stable and unstable thoracolumbar injury patterns, examine cord and cauda equina function, select CT and MRI stepwise, and protect alignment while specialist operative or non-operative care is agreed.
- Use mechanism and full-spine examination: a single painful level does not exclude non-contiguous fracture, particularly with high energy or an ankylosed spine.
- Document leg myotomes, dermatomes, reflexes and sacral sensation, deep anal pressure and voluntary contraction when cord, conus or cauda equina injury is possible.
- Compression wedge affects mainly anterior body; burst includes posterior-wall failure and retropulsion; flexion-distraction fails the posterior tension band; translation or rotation is highly unstable.
Key red flags
New leg weakness, sensory level, saddle anaesthesia, urinary retention, reduced anal tone or bilateral radicular pain indicates cord, conus or cauda equina compromise requiring emergency MRI and spinal review.
Investigation priorities
Define acute bone morphology, alignment and canal compromise.
Management branches
Thoracolumbar pain, high-risk mechanism or neurological symptoms follow trauma.
- Run ABCDE, control haemorrhage and maintain the safest alignment using coordinated transfer, especially in ankylosing disease.
- Examine the whole spine and document motor, sensory and sacral function, bladder symptoms and abdominal signs.
Imaging and repeated examination define morphology, neurology and posterior-ligament concern.
Key medicines
Paracetamol as baseline fracture analgesiaGive 1 g orally four times daily at intervals of at least 4 hours, maximum 4 g in 24 hours; reduce the maximum for body weight below 50 kg, frailty, malnutrition, chronic alcohol excess or liver impairment.