Management of flexion distraction injuries to the thoracolumbar spine

• Flexion distraction injuries (FDI) are unstable injuries that require surgical stabilization.
• Compression or distraction, while the neck is flexed, can produce FDI.
• The literature most supports long-segment posterior fixation with or without interbody fusion.
• Minimally invasive surgery (MIS) posterior fixation is a viable option when decompression is not required.

We present an updated overview of the literature regarding the management of flexion distraction injuries (FDI). FDI are unstable fractures of the thoracolumbar spine, which require surgical management by long segment open fusion or minimally invasive posterior fixation with pedicle screws. While associated with concomitant intra-abdominal injuries that may delay operative stabilization, FDI frequently involve reversible spinal cord injuries and rapid correction is indicated. Modern biomechanical studies have identified valuable prognostic indicators that may be elucidated from determining the mechanism of injury, including the degree of flexion and presence of compression at the time of injury. An improved understanding of FDI will contribute to more appropriate diagnoses and treatment of these fractures.