Abstract
Background: The management of traumatic upper thoracic spine fractures (T1–T6)
is complex due to the unique biomechanical/physiological characteristics of these
levels and the nature of the injuries. They are commonly associated with multiple
other traumatic injuries and severe spinal cord injuries. We describe the safety
and efficacy of surgery for achieving stability and maintaining reduction of upper
thoracic T1–T6 spine fractures.
Methods: We retrospectively analyzed a series of traumatic unstable upper
thoracic (T1–T6) spine fractures treated at one institution between 1993 and 2016.
All patients were assessed neurologically and underwent complete preoperative
radiographic analysis of their T1–T6 spine fractures including assessment of
instability. Neurological and radiographic outcomes including fusion rates, kyphotic
deformity, and successful reduction of the fracture were evaluated along with hospital
length of stay (LOS), intensive care unit LOS, and overall complication rates.
Results: There were 43 patients (29 males, 14 females) with an average
age of 37.7 years. Between 1993 and 1999, 8 patients were treated with
hook/rod constructs, whereas between 1995 and 2016, 35 patients received pedicle
screw fixation utilizing intraoperative fluoroscopy or computed tomography (CT)
navigation. Forty‑three patients had a total of 178 levels fused. In this series, there
were no intraoperative vascular or neurological complications. Instrumentation
was removed in five patients due to pain, wound infection, or hardware failure.
The mean hospital LOS was 21.1 days (range 4–59 days), and there was a 95%
fusion rate based on follow‑up imaging (X‑rays or CT scan).
Conclusions: Surgical treatment of upper thoracic spine fractures (T1–T6), although
complex, is safe and effective. Reduction and fixation of these fractures decreases
the risk of further neurological complications, allows for earlier mobilization, and
correlates with shorter hospital LOS and improved outcomes.