UNSTABLE FRACTURES OF THE UPPER THORACIC SPINE

Unstable fractures of the upper thoracic spine are a therapeutic chall enge because of the high rate of associated injuries and frequent occu rrence of spinal cord lesions. This study focuses on the operative tre atment of these injuries. We present nine patients with unstable injur ies of the upper thoracic spine. According to the classification of Ma gerl et al., there are seven type C and two type B fractures. Eight pa tients had complete transverse lesions of the cord and one had no evid ence of spinal cord injury. All patients presented associated injuries : nine patients had fractured ribs, three a fractured sternum and thre e a severe haemothorax. All underwent operative treatment: six posteri or fusions only, two anterior interbody fusions only after thoractotom y owing to severe bleeding from ruptured intercostal arteries, and one a combined fusion after failure of posterior fusion. The treatment of these patients should be individualized, depending on the associated injuries, loss of blood owing to fractured spine and ruptured vessels and depending on the back pain resulting from an unstable thorax. In g eneral, we prefer the posterior approach to unstable fractures of the upper thoracic spine.