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. 2016 Jul 21;13(4):383-8.
doi: 10.1016/j.jor.2016.06.019. eCollection 2016 Dec.

The epidemiology of thoracolumbar trauma: A meta-analysis

Yoshihiro Katsuura  1 , James Michael Osborn  1 , Garrick Wayne Cason  1
Affiliations

The epidemiology of thoracolumbar trauma: A meta-analysis

Yoshihiro Katsuura et al. J Orthop. .

Abstract

Purpose: To describe the epidemiology of thoracolumbar fractures and associated injuries in blunt trauma patients.

Methods: A systematic review and metaanalysis was performed based on a MEDLINE database search using MeSH terms for studies matching our inclusion criteria. The search yielded 21 full-length articles, each sub-grouped according to content. Data extraction and multiple analyses were performed on descriptive data.

Results: The rate of thoracolumbar fracture in blunt trauma patients was 6.90% (±3.77, 95% CI). The rate of spinal cord injury was 26.56% (±10.70), and non-contiguous cervical spine fracture occurred in 10.49% (±4.17). Associated injury was as follows: abdominal trauma 7.63% (±9.74), thoracic trauma 22.64% (±13.94), pelvic trauma 9.39% (±6.45), extremity trauma 18.26% (±5.95), and head trauma 12.96% (±2.01). Studies that included cervical spine fracture with thoracolumbar fracture had the following rates of associated trauma: 3.78% (±5.94) abdominal trauma, 21.65% (±16.79) thoracic trauma, 3.62% (±1.07) pelvic trauma, 18.36% (±4.94) extremity trauma, and 15.45% (±11.70) head trauma. A subgroup of flexion distraction injuries showed an associated intra-abdominal injury rate of 38.70% (±13.30). The most common vertebra injured was L1 at a rate of 34.40% (±15.90). T7 was the most common non-junctional vertebra injured at 3.90% (±1.09). Burst/AO type A3 fractures were the most common morphology 39.50% (±16.30) followed by 33.60% (±15.10) compression/AO type A1, 14.20% (±8.08) fracture dislocation/AO type C, and 6.96% (±3.50) flexion distraction/AO type B. The most common etiology for a thoracolumbar fracture was motor vehicle collision 36.70% (±5.35), followed by high-energy fall 31.70% (±6.70).

Conclusions: Here we report the incidence of thoracolumbar fracture in blunt trauma and the spectrum of associated injuries. To our knowledge, this paper provides the first epidemiological road map for blunt trauma thoracolumbar injuries.

Keywords: Abdominal injury; Blunt trauma; Cervical spine; Epidemiology; Fracture; Meta-analysis; Spinal cord injury; Spine; Thoracic injury; Thoracolumbar; Trauma.

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Figures

Fig. 1
Fig. 1
Search algorithm used to select articles for analysis. Search terms initially yielded 1870 articles, 68 of which were selected for analysis of abstract based on inclusion and exclusion criteria. Another 42 articles were removed because they were too specific in their focus or lacked relevant data. This yielded 26 articles for full text analysis. Another 7 articles were included from manual cross-referencing. From these, 12 articles lacked relevant epidemiological data and were excluded to leave 21 relevant articles that were eventually selected for analysis of the full text. Some articles were utilized twice for different analyses. Abbreviations: Fx: fracture, SCI: spinal cord injury.
Fig. 2
Fig. 2
Random effects model of the rate of thoracolumbar fractures in blunt trauma patients. Summary effect highlighted in red, individual studies in blue.
See this image and copyright information in PMC

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