Thoracolumbar Fracture Classification System A New Approach Spine
Thoracolumbar Fracture Classification System A New Approach Spine Trauma Study Group Alexander R Vaccaro M. D. Professor Thomas Jefferson University Department of Orthopaedics and the Rothman Institute
Spine Trauma Study Group Thoracolumbar Classification System Three Part Description Fracture Description (Morphometric) Neurologic Status Integrity of PLC
Fracture Description (Morphology) • Compression-axial, flexion, distraction, translation/rotation • Distraction- extension, flexion, translation/rotation, compression • Translation/Rotation-flexion, distraction
Neurologic Status • Intact • Nerve Root Injury • Cauda Equina Injury • Cord Injury-Incomplete, Complete
Posterior Ligamentous Complex • Intact • Disrupted In Tension
Treatment Determined by: • Mechanism • Neurology • Ligament/ bone Integrity
Mechanism-Point System Two Component Mechanistic Description Compression 1 Distraction 3 Translation / Rotation 3
Neurology-Point System Intact 0 Nerve root Cauda equina 3 1 Cord Incomplete 3 Complete 2
Stability-Soft Tissue Point System Ligaments Intact 0 PLC Injured 3 Evaluated by MRI
Stability Spinal Column Point System Spinal Column Anterior Posterior 1 1 Middle 1
Next Step - Direct TX Assign Points Conservative Surgery
Point System Mechanism Translation/Rotation - 3 Distraction - 3 Compression - 1 Neurology Cauda equina - 3 Incomplete - 3 Complete - 2 Root - 1 Ligament PLC - 3 Spinal Column Anterior - 1 Middle - 1 Posterior - 1
Treatment • • • Fractures with 4 points or less = non operative Fractures with 5 points=Nonop vs Op Fractures with 6 points or more = surgery
Examples Anterior Compression Fx • Compression ( mechanism) - 1 • Intact (neurology) - 0 • PLC (ligament) no injury - 0 • Anterior Column - 1 Total 2 points- Non Op
Example Stable Burst Fracture • Compression (mechanism) - 1 • Intact ( neurology) - 0 • PLC (ligament) no injury (0) • Ant/Middle column 1+1 Total 3 points-Non Op
Example Unstable Burst-Complete Neuro Injury • Compression (mechanism) -1 • Complete (neurology) - 2 • PLC (ligament) injury - 3 • Ant/Middle column -1+1 Total 8 points-Surgery
Example Stable Burst-Complete injury • • Compression-1 Complete neurology-2 PLC Intact-0 Anterior, Middle Column disruption- 1+1 Points 5 -Non Op vs Op
Example Fx Dislocation • Translation/rotation - distraction (mechanism) - 3 + 3 • Complete (neurology) - 2 • PLC (ligament) injury - 3 • Anterior column - 1 Total 12 points. Surgery
Surgically Indicated Patients Approach Selection Neurology Ligament Status Modifiers
Approach Selection Neurologically Intact Ligament Injury present Posterior alone vs. Anterior alone vs. Combined
Approach Selection Neurologically Incomplete Ligament Injury No Anterior Yes Combined vs Anterior Modifier – Osteoporosis Combined
Approach Selection Neurologically Complete Injury Posterior
Thoracolumbar Fracture Classification System • Point system to determine nonoperative vs operative treatment • Neurology, ligamentous status helps determine surgical approach • Validation necessary
Thank You
- Slides: 24