Common vertebral fracture level after the 2023 turkey earthquake, thoracolumbar junction, due to hyper-flexed and fixed posture at trýangle of life areas

Abstract

AIM:To assess the frequency of thoracolumbar junction (TLJ) fractures (T10-L2) in survivors of the 2023 East Turkey earthquake. MATERIAL and METHODS:This single-center retrospective stdy evaluated 10 earthquake survivors, who were trapped under the rubble and rescued alive by rescue teams, and were assessed for spinal trauma after the earthquake in Eastern Turkey on February 6, 2023. All patients underwent full spinal magnetic resonance imaging and computed tomography examinations to determine the level of spinal fracture and decide the treatment methods. RESULTS:All patients had sustained spinal fractures. Eight underwent surgery, while two were managed conservatively. Nine out of ten patients had TLJ fractures. Five patients had L1 fractures, four of them were treated surgically. Three patients had a T12 level fracture, two of whom were treated surgically. One patient with a T7-level fracture was treated surgically. Only one patient had multiple fractures (T12 and L2 levels) and was treated surgically. CONCLUSION:The TLJ was the commonest vertebral fracture level as of the 2023 Turkey earthquake survivors in our study population. In the event of an earthquake, people tend to attain a fetal posture (fix and hyperflex the spine) when taking shelter in a narrow area (triangle of life). This position might place an excessive load on the TLJ, predisposing it to injuries.

Thoracolumbar fractures after the 2023 Türkiye earthquake and controversial mechanism of occurrence

“…T2-weighted MRI sequences are particularly useful for identifying hematoma, whereas STIR images facilitate the detection of spine fractures, edema, and spinal ligament injuries. [8] In this study, we opted for CT scans to visualize fractures more effectively, while MRI was preferred for identifying spinal cord injuries.…”

“…Consistently across studies, the thoracolumbar region, particularly the thoracolumbar junction, is identified as the most commonly affected spinal segment in earthquake-related injuries, a finding that aligns with our study. [3,4,8,[13][14][15][16][17][18] Various studies have sought to understand why the thoracolumbar region is so frequently affected in spinal fractures resulting from earthquakes. Alpergin et al [8] suggested that the high incidence of thoracolumbar junction involvement is due to the tendency of individuals to adopt a hyperflexed posture during an earthquake, seeking to protect themselves.…”

“…[3,4,8,[13][14][15][16][17][18] Various studies have sought to understand why the thoracolumbar region is so frequently affected in spinal fractures resulting from earthquakes. Alpergin et al [8] suggested that the high incidence of thoracolumbar junction involvement is due to the tendency of individuals to adopt a hyperflexed posture during an earthquake, seeking to protect themselves. Our study, which included 14 patients (82.35%) with thoracolumbar fractures, did not reach a definitive conclusion on this matter.…”

“…[5][6][7] The region most commonly affected by spinal injuries caused by earthquakes is the thoracolumbar junction . [8] This transitional area between the less mobile thoracic spine and the more mobile lumbar vertebrae is inherently more vulnerable to injury. [9] While there are studies on earthquake-related spinal trauma in the literature, information on this topic remains limited.…”