thoracolumbar fracture classification system a new approach spine trauma study group alexander r...
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Thoracolumbar FractureClassification System
A New ApproachSpine Trauma Study Group
Alexander R Vaccaro M.D.Professor
Thomas Jefferson UniversityDepartment of Orthopaedics
and the Rothman Institute
Thoracolumbar FractureClassification System
A New ApproachSpine Trauma Study Group
Alexander R Vaccaro M.D.Professor
Thomas Jefferson UniversityDepartment of Orthopaedics
and the Rothman Institute
Spine Trauma Study Group Thoracolumbar
Classification SystemThree Part Description
Spine Trauma Study Group Thoracolumbar
Classification SystemThree Part Description
Fracture Description (Morphometric)
Neurologic Status
Integrity of PLC
Fracture Description (Morphology)
Fracture Description (Morphology)
•Compression-axial, flexion,distraction,translation/rotation
•Distraction- extension,flexion,translation/rotation, compression
•Translation/Rotation-flexion, distraction
•Compression-axial, flexion,distraction,translation/rotation
•Distraction- extension,flexion,translation/rotation, compression
•Translation/Rotation-flexion, distraction
•Intact•Nerve Root Injury•Cauda Equina Injury•Cord Injury-Incomplete, Complete
•Intact•Nerve Root Injury•Cauda Equina Injury•Cord Injury-Incomplete, Complete
Neurologic StatusNeurologic Status
Posterior Ligamentous Complex Posterior Ligamentous Complex
•Intact
•Disrupted In Tension
•Intact
•Disrupted In Tension
•Mechanism
•Neurology
•Ligament/ bone Integrity
•Mechanism
•Neurology
•Ligament/ bone Integrity
TreatmentDetermined by:TreatmentDetermined by:
Mechanism-Point SystemMechanism-Point System
Compression1
Distraction3
Translation /Rotation
3
Two Component Mechanistic Description
Neurology-Point SystemNeurology-Point System
Cauda equina
Cord
Incomplete Complete
Nerve root3
3 2
1
Intact0
Stability-Soft Tissue Point System
Stability-Soft Tissue Point System
Ligaments
PLC
Evaluated by MRI
Intact 0
Injured 3
Stability Spinal Column Point SystemStability Spinal Column Point System
Spinal Column
Anterior
Middle
Posterior1
1
1
Next Step - Direct TXNext Step - Direct TX
Assign Points
Conservative
Surgery
Point SystemPoint System
Neurology
Root - 1Complete - 2Incomplete - 3
Cauda equina - 3
LigamentPLC - 3
Spinal ColumnAnterior - 1
Middle - 1
Posterior - 1
Mechanism
Translation/Rotation - 3Distraction - 3
Compression - 1
TreatmentTreatment
•Fractures with 4 points or less = non operative
•Fractures with 5 points=Nonop vs Op
•Fractures with 6 points or more = surgery
•Fractures with 4 points or less = non operative
•Fractures with 5 points=Nonop vs Op
•Fractures with 6 points or more = surgery
•Compression ( mechanism) - 1
•Intact (neurology) - 0
•PLC (ligament) no injury - 0
•Anterior Column - 1
•Compression ( mechanism) - 1
•Intact (neurology) - 0
•PLC (ligament) no injury - 0
•Anterior Column - 1
ExamplesAnterior Compression Fx
ExamplesAnterior Compression Fx
Total 2 points- Non Op
•Compression (mechanism) - 1•Intact ( neurology) - 0•PLC (ligament) no injury (0)•Ant/Middle column 1+1
•Compression (mechanism) - 1•Intact ( neurology) - 0•PLC (ligament) no injury (0)•Ant/Middle column 1+1
ExampleStable Burst Fracture
ExampleStable Burst Fracture
Total 3 points-Non Op
•Compression (mechanism) -1
•Complete (neurology) - 2
•PLC (ligament) injury - 3
•Ant/Middle column -1+1
•Compression (mechanism) -1
•Complete (neurology) - 2
•PLC (ligament) injury - 3
•Ant/Middle column -1+1
Example
Unstable Burst-Complete Neuro Injury
Example
Unstable Burst-Complete Neuro Injury
Total 8 points-Surgery
ExampleStable Burst-Complete injury
ExampleStable Burst-Complete injury
• Compression-1
• Complete neurology-2
• PLC Intact-0
• Anterior, Middle Column disruption- 1+1
Points 5-Non Op vs Op
• Compression-1
• Complete neurology-2
• PLC Intact-0
• Anterior, Middle Column disruption- 1+1
Points 5-Non Op vs Op
•Translation/rotation - distraction (mechanism) - 3 + 3
•Complete (neurology) - 2
•PLC (ligament) injury - 3
•Anterior column - 1
•Translation/rotation - distraction (mechanism) - 3 + 3
•Complete (neurology) - 2
•PLC (ligament) injury - 3
•Anterior column - 1
ExampleFx Dislocation
ExampleFx Dislocation
Total 12 points-Surgery
Surgically Indicated Patients
Approach SelectionSurgically Indicated Patients
Approach SelectionNeurologyNeurology
Ligament StatusLigament Status
ModifiersModifiers
Approach SelectionApproach Selection
Neurologically IntactNeurologically Intact
Ligament Injury presentLigament Injury present
Posterior alone vs.Anterior alone vs.Combined
Posterior alone vs.Anterior alone vs.Combined
Approach SelectionApproach SelectionNeurologically IncompleteNeurologically Incomplete
Ligament InjuryLigament InjuryNoNo YesYes
AnteriorAnterior Combined vsAnteriorCombined vsAnterior
Modifier – Osteoporosis CombinedModifier – Osteoporosis Combined
Approach SelectionApproach Selection
Neurologically Complete InjuryNeurologically Complete Injury
Posterior Posterior
Thoracolumbar Fracture Classification System
Thoracolumbar Fracture Classification System
•Point system to determine nonoperative vs operative treatment
•Neurology, ligamentous status helps determine surgical approach
•Validation necessary
•Point system to determine nonoperative vs operative treatment
•Neurology, ligamentous status helps determine surgical approach
•Validation necessary
Thank You Thank You