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The thoracolumbar junction, from T11 to L2, is the most commonly injured portion of the spinal column. Over 15, major thoracolumbar spine injuries occur per year in the United States, with over 5, resulting in neurological deficits. Identifying these injuries is paramount to prevent secondary neurologic injury and assist in clinical decision-making. Several classification schemes are in use to describe these fractures, determine their overall stability, and help predict which fractures will require operative versus non-operative management. Some types of fractures are conventionally treated with or without surgery, but there still remains controversy regarding how to best manage certain fractures. The management for each of these fractures will be discussed with respect to their fracture morphology, neurologic injury, and spinal stability. ICU management of patients with severe TBI has focused on intracranial pressure ICP and cerebral perfusion pressure CPP, but this approach was never validated in a randomized clinical trial, and recent studies have questioned the benefit of ICP-directed therapies. These studies indicate that a strategy focused on ICP may be overly simplistic. Some have suggested that monitoring the partial pressure of oxygen in brain tissue PbtO 2 provides a useful marker of tissue metabolism, and that interventions based on PbtO 2 may improve patient's outcome. However, existing studies using non-randomized designs have conflicting results.

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