gms | German Medical Science

Objective: Hyperextension injuries [HEIs] of the thoracolumbar spine are supposed to be rare. The literature contains only asmall number of case reports and studies with few participants. During the last 20 years a striking increase in the frequency of these HEIs was noticed.

Methods: Between 01/1997 and 10/2017 our prospective database included 117 patients with 123 HEIs of the thoracolumbar spine (30 women and 87 men, average age 71.2 ± 14.0 y, range 25 – 93 y). The data were analyzed retrospectively. CT scans and MRI scans were evaluated. The injury patterns of the anterior column were differentiated into 3 groups: transosseous, transdiscal and combined forms, in which both the disc space and the vertebral body were affected. At the posterior column, osseous and ligamentous injuries were differentiated. A classification system with 6 different types of HEIs resulted from the combinations of these groups (Figure 1 [Fig. 1]).The diagnosis of DISH (diffuse idiopathic skeletal hyperostosis) was made according to the criteria by Resnick and Niwayama. Values were expressed as the mean and standard error of the mean. Standardized statistical test (t test, Wilcoxon test, Mann-Whitney U test) were used for comparison.

Results: 117 patients with 123 HEIs of the thoracolumbar spine were analyzed. 88 (72%) HEIs were associated with DISH, 19 (14%) with ankylosing spondylitis, and 7 (6%) with spondylosis deformans. Only 9 (7%) of these injuries involved patients without ankylosing spinal disease. 68 (55%) injuries involved the thoracic region (Th1 – 10), 50 (42%) the thoracolumbar junction (Th 11 – L2) and only 4 (3%) the lumbar spine (L3 – L5). During the period of the study 2779 acute injuries involving the thoracolumbar spine were treated operatively. These injuries included 106 (3.8%) HEIs. 17 HEIs received non-operative treatment. 17 out of 19 patients with ankylosing spondylitis had an osseous disruption of the anterior and posterior column (Type 4). Within the group of DISH 46 patients (55%) had transosseous injuries of the anterior column, followed by 26 patients (29%) with transdiscal lesions and 16 (15%) with combined injuries. In this group the posterior column showed injuries of the bone in 24 of 88 patients (28%) and of the ligamentous complex in 61 of 85 patients (72%). 19 of 113 patients (17%) also had suffered spinal cord injury.

Conclusion: To our knowledge, this study is by far the largest cohort of patients with HEIs of the thoracolumbal spine. It provides important data about epidemiology, localization andfracture morphology.