ESTES recommendation on thoracolumbar spine fractures

Spinal trauma is less common than other musculoskeletal injuries, yet leads to more disability and costs.In recent decades reliable classification and injury assessment systems have been published and surgical techniques have greatly improved.There are many new insights into the principles and timing of the treatment of thoracolumbar injuries, but many unsolved problems remain:1. Role and timing of medical and surgical interventions for patients with associated neurological injury.2. Timing of surgical intervention in patients with multiple injuries.3. Wide variation in practice between operative versus nonoperative management, without clear reasons.4. The role of different surgical approaches and techniques in certain injury types is not clarified yet.5. Methods of non-operative management.6.No consensus is found yet for the care of elderly patients with concurrent complex disorders [1].After initial assessment and management, a decision about the definitive treatment has to be made.There are two possibilities: conservative or operative treatment.The decision depends on the severity of the fracture (classification), spinal cord injury and possible comorbidity, and must be made together with the patient (shared decisionmaking).There are many different ways to treat a patient, both conservative and operative.Because of the impact of thoracolumbar injuries and the many options for treating these injuries, the European Society of Trauma and Emergency Surgery established a working group on this topic.