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

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