classification of thoracolumbar spine injuries abdulaziz alomar, md, msc frcsc assistant professor...
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![Page 1: Classification of Thoracolumbar spine injuries Abdulaziz Alomar, MD, MSc FRCSC Assistant Professor and consultant Orthopaedic surgeon. KKUH, KSU](https://reader037.vdocuments.us/reader037/viewer/2022103112/551c4144550346b1458b4572/html5/thumbnails/1.jpg)
Classification of Thoracolumbar spine injuries
Abdulaziz Alomar, MD, MSc FRCSC
Assistant Professor and consultant Orthopaedic surgeon.
KKUH, KSU
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Historical Classification Systems
System Summary Comments
Nicoll Differentiates stable from unstable fractures
Serves as a foundation for subsequent classification systems
Holdsworth Modifies previous classification systems to include the mechanisms of injury and two-column theory
Fails to appreciate some burst fracture instabilities
Kelly & Whitesides Refines the two-column model Classification guides treatment of neurologic deficit
Denis Development of the three-column model
The middle column is the primary determinant of mechanical stability.
Gertzbein et al. Suggests a posterior component, anterior component and body component
Involves the vertebral body as it
relates to kyphosis.
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Denis
• Goal:– To emphasize pathologic anatomy of different
types of spinal injuries, each of which was based on a different mechanism of injury.
– did not consider methods of treatment or the results.
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Denis: Three-column model
Anterior column- formed by the ALL, the anterior annulus, and the anterior portion of the vertebral body
Middle osteoligamentous- the critical feature. Very important to spinal stability; consists of PLL, the posterior portion of the annulus, and the posterior aspect of the vertebral body
Posterior column- includes the neural arch, facet joints and capsules, ligamentum flavum, and remaining ligamentious complex
Denis F. Clin Orthop Relat Res. 1984
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Denis: Middle-column concept
• Developed to define burst fracture
middle column is the primary determinant of mechanical stability of the thoracolumbar region of the spine.
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Isolated fractures of– Transverse process. – Articular process. – pars interarticularis, or– Spinous process.
Denis- Minor injuries
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Denis- Major injuries
Compression type
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Denis- Major injuries
Burst Type
E
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Seat belt type
Denis- Major injuries
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Fracture dislocation typeDenis- Major injuries
Flexion rotation Flexion distraction
Shear type
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Load Sharing Classification
• Created system in response to poor patient outcomes when the vertebral body sustained a disproportionately severe injury
Classification system grades: Amount of damaged vertebral body Spread of the fragments in the fracture sight Amount of corrected kyphosis
McCormack et al. Spine, 1994
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Load Sharing Classification
• Load-Sharing Classification: a straight-forward way to describe the amount of bony comminution in a spinal fracture
• Can help the surgeon select short-segment pedicle-screw-based fixation using the posterior approach for less comminuted injuries and the anterior approach for those more comminuted injuries .
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Load sharing classification
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AO Classification
• Based on the review of 1445 consecutive thoracolumbar injuries
• Primarily based on pathomorphological criteria
• Categories based on:– Main mechanism of injury– Pathomorphological uniformity– Prognostic aspects regarding healing potential
Magerl et al. Eur Spine J. 1994.
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AO Classification
• Classification reflects progressive scale of morphological damage by which the degree of instability is determined
• Consists of a 3-3-3 grid for sub-grouping injuries into three types:– A, B and C– Every type has three groups, each of which contains
three subgroups with specifications
Magerl et al. Eur Spine J. 1994.
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AO Classification
• Types have a fundamental injury pattern which is determined by the three most important mechanisms acting on the spine
– Compression– Distraction– Axial torque
Magerl et al. Eur Spine J. 1994.
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AO ClassificationType A(compression)
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AO ClassificationType B (Distraction)
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AO ClassificationType C (Torsion)
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Examples of AO Classification
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AO Classification-
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AO Classification
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AO Classification
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Summary
Currently no classification system that has achieved global clinical utility and acceptance.
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