Epidemiology

The rate of thoracolumbar fracture in blunt trauma patients is 4% to 7%.[12][13]​​​​​ The most common cause of thoracolumbar fractures are traffic accidents and falls.[9][14]​​​ Increasing rates of thoracolumbar spine fractures have been seen in the US over the past several decades, despite a decline in other motor vehicle-related injuries, likely due to a combination of both increased detection of thoracolumbar spine injury and increased rate of seatbelt injury.[13]​ A trend toward increased fractures rates in developing countries has been attributed to an increase of motor vehicle accidents.[9]​ A 2018 study described a mean age of 49.1 ± 17.7 years.[15] Older patients may present with thoracolumbar fractures as a result of low-energy trauma, for example, falls from standing, due to diminished bone mineralization commonly present in older patient populations, and coexisting osteoporosis.[9][10]​​ Falls are about 2.8 times more likely to cause injury in older people (ages >65 years) than in people <65 years.[16] Up to 70% of osteoporotic fractures remain undiagnosed.[17]​ See Osteoporotic spinal compression fractures.

Thoracolumbar spine trauma is more common in males than in females. Reported male-to-female ratios vary; one 2018 study detailed a ratio of 1.4:1, whereas a 1991 paper gave a ratio of 4:1.[15][18]​ This shift may be explained by females more frequently taking part in higher-risk activities today than they did in previous decades.

Pediatric patients comprise 1% to 5% of spinal injury admissions.[19] In pediatric populations, the spinal cord can be injured without disruption of the spinal column - a condition defined as SCIWORA (spinal cord injury without radiologic abnormality).[20][21]​ Children may be more susceptible to SCIWORA than adults because of the relatively higher elasticity of spinal ligaments allowing for greater deformation forces on the spinal cord, without fracturing or dislocating the vertebrae.[20]​ SCIWORA involves the thoracolumbar spine less frequently than the cervical spine.[20][22]​ SCIWORA occurs in 42% of patients under 9 years old, and 8% of patients 15-17 years old.​​[23]

Thoracic and lumbar fractures account for around 48% and 32% of all spinal injuries, respectively, and most occur between thoracic spine T11,T12, and lumbar spine L1.[24][25] Multilevel spinal fractures are present in around one quarter of spinal injury patients.[25][26] Most isolated fractures are related to osteoporosis.[27][Figure caption and citation for the preceding image starts]: MRI lumbar spine: sagittal view (T2-weighted sequence) showing an osteoporotic fracture of the T12 vertebral bodyFrom the personal collection of Dr B. Nurboja and Mr D. Choi [Citation ends].com.bmj.content.model.Caption@3cd2dbe8

Around 35% to 50% of patients with spinal injuries have associated neurologic involvement.[14][28]​​​ Spinal cord injuries occur in the thoracic region in 17% of cases, and the lumbar region in 20% to 24% of cases.[29] Patients with these injuries commonly have other associated injuries, such as concurrent multiple system injuries (80%) and head injuries (41%).[30][31]

Use of this content is subject to our disclaimer