Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technnique.

Despite recent advances in surgical techniques and instrumentation, two issues in the treatment of thoracic and lumbar remain contested: (1) the indications for surgical intervention; and (2) the optimal approach to obtain decompression, realignment, and fusion of the disrupted segment (anterior, posterior, or combined). Choosing among the options requires the ability to define accurately the extent of the injury to both the structural and the neurologic elements of the spine as well as an appreciation of the historic rationale of individual treatment methods.