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Oliver I. Schmidt, Ralf H. Gahr Trauma Centre St. Georg Clinic Leipzig, Germany Pitfalls in Spinal Fracture Classification.

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Presentation on theme: "Oliver I. Schmidt, Ralf H. Gahr Trauma Centre St. Georg Clinic Leipzig, Germany Pitfalls in Spinal Fracture Classification."— Presentation transcript:

1 Oliver I. Schmidt, Ralf H. Gahr Trauma Centre St. Georg Clinic Leipzig, Germany Pitfalls in Spinal Fracture Classification

2 CLASSIFICATION Magerl, M. Aebi, et al., A Comprehensive Classification Of Thoracic and Lumbar Injuries, Eur Spine J (1994) 3: Comprehensive Classification for Type of vertebral fracture and injury mechanism Treatment options can be based on classification result Standardized Nomenclature, Golden Standard Separation into stable and unstable conditions

3 A Groups Subgroups Compression C Groups Subgroups Axial torque B Groups Subgroups Disruption Disruption Three fundamental types of injury CLASSIFICATION

4 Pure axial compression force => No Injury to Posterior Column Compression injury of the anterior (and medial) column, only Osteoporotic fractures: old vs. fresh/active PITFALL TYPE A Type A – Vertebral Body Compression

5 AVOID PITFALL 3. X-Ray: -Check for sclerosis of fractured vertebra -Look for additional fractures in the spinal column 1. Check history of point of injury 4. If available or in doubt, go for MRI (T2-Fat saturated) 2. Do check for local pain / association to fracture height TYPE A

6 Where´s the fresh osteoporotic # ?! TIRM T2wTSE T1w ? TYPE A

7 Type B1.1: Posterior ligament. Lesion Hyperflexion of the spine => Injury to Posterior Column Ruptur to PLC presents w/o signs of vertebral fracture PITFALL TYPE B

8 3. X-Ray: -Check Alignement of all three spinal columns -Look for widened interspinous space in PLC -Look for facet diastasis/luxation 1.Check history for any distraction/hyperflexion injury 4. If available or in doubt, go for MRI 2. Clinical Signs of posterior injury: local tenderness, Hematoma, Proc. Spinosi #, Supraspinous Lig. # TYPE B AVOID PITFALL

9 Type B1.2: Posterior Distraction – Anterior Compression Hyperflexion of the spine Posterior distraction Posterior Column Injury Anterior Compression vertebral compression fracture vertebral fracture is recognized but posterior injury overlooked PITFALL TYPE B

10 If Type A injury is diagnosed, always assume injury to posterior column: 3. X-Ray: -Check Alignement of all three spinal columns -Look for widened interspinous space in PLC -Look for facet diastasis/luxation - Look for pedicle fracture, ? Pedicle Position 1. Check history for any distraction/hyperflexion injury 4. If available or in doubt, go for MRI 2. Clinical Signs of posterior injury TYPE B AVOID PITFALL

11 Type B2: Posterior Distraction w. osseous Lesion Hyperflexion of the spine Posterior distraction Injury to Posterior Column Traumatic Spondylosis TYPE B

12 Type B3: Anterior Distraction Hyperextension of the spine Anterior distraction Anterior Column Injury pure discoligamentous Injury w/o vertebral fracture Discoligamentous injury w/o signs of vertebral fracture PITFALL TYPE B

13 => Characteristic injury mechanism TYPE B Type B3: Anterior Distraction

14 1.Check history for any hyperextension injury 3. If available or in doubt, go for MRI 2. Rule out intraabdominal injury: Hyperextension can lacerate mesenteric trunc or Pancreas => Abdominal Exam, Ultrasound, CT TYPE B AVOID PITFALL

15 Type C1: Rotational/Axial Injury with compression Axial Rotation & Type A injury of the spine => Instability TYPE C Type A fracture diagnosed, but Signs of Rotational Injury overlooked PITFALL

16 3. X-Ray: -Check for Signs of discoligamentous injury - Signs of Rotational Injury: Transverse Proc. #, lateral vertebral bulge Fragment, asymmetrical vertebral # 4. If available or in doubt, go for MRI 2. Rule out intraabdominal injury: Rotation can lacerate mesenteric trunc or Pancreas => Abdominal Exam, Ultrasound, CT TYPE C AVOID PITFALL 1.Check history for any rotational injury (insufficient data, in most cases)

17 TYPE C Stable Type A Fracture ?!

18 TYPE C Stable Type A Fracture ?! Exzentric Proc. Spin. Fracture of Proc. Transv. Lateral Bulge => Nope ! Unstable Type C1

19 Type C2: Rotational/Axial Injury with distraction Axial Rotation & Type B Injury of the spine => Instability TYPE C Type B fracture diagnosed, but Signs of Rotational Injury overlooked PITFALL

20 Type C3: Pure Rotational/Axial Injury Pure Axial Rotation Injury of the spine => Instability TYPE C

21 CAVE ! - Smooth transition from Type A to B and C Fractures - Always rule out higher grade injury GUIDELINES Type A Stable Type C Unstable Type B

22 Thank You


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