Indicazioni al trattamento delle fratture vertebrali toraciche e lombari

Fracture type and related concepts of stability, neurological complications, polytrauma, age and general conditions are the major factors conditioning type and timing of surgical treatment of thoracic and lumbar injuries. Based on a series of 488 cases collected along 10 years, the criteria for a decision-making process are described and surgical technique and related complications are discussed. Emergency or at least early posterior surgical approach is proposed for the best reduction of axial dislocation, neurological decompression and sound fixation. The advantages of early treatment are: higher probability of neurological recovery, better pain control and nursing, earlier functional recovery. Specific morbidity related to early treatment should be carefully considered by the anesthesiological team. Pedicular screws seem biomechanically better than hooks. The role of mininvasive techniques is increasing. Delayed anterior approach for fixation and fusion must be considered in case of incomplete reconstruction of the anterior column, whose continuity is mandatory for stability and balance.