Presentation is loading. Please wait.

Presentation is loading. Please wait.

Classification of Thoracolumbar spine injuries

Similar presentations

Presentation on theme: "Classification of Thoracolumbar spine injuries"— Presentation transcript:

1 Classification of Thoracolumbar spine injuries
Abdulaziz Alomar, MD, MSc FRCSC Assistant Professor and consultant Orthopaedic surgeon. KKUH, KSU

2 Historical Classification Systems
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.

3 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.

4 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

5 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.

6 Denis- Minor injuries Isolated fractures of Transverse process.
Articular process. pars interarticularis, or Spinous process.

7 Denis- Major injuries Compression type

8 Denis- Major injuries Burst Type E

9 Denis- Major injuries Seat belt type

10 Denis- Major injuries Fracture dislocation type Shear type
Flexion rotation Flexion distraction

11 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

12 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 .

13 Load sharing classification


15 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

16 AO Classification Classification reflects progressive scale of morphological damage by which the degree of instability is determined Consists of a 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

17 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

18 AO Classification Type A(compression)

19 AO Classification Type B (Distraction)

20 AO Classification Type C (Torsion)

21 Examples of AO Classification

22 AO Classification-

23 AO Classification

24 AO Classification

25 Summary Currently no classification system that has achieved global clinical utility and acceptance.


Download ppt "Classification of Thoracolumbar spine injuries"

Similar presentations

Ads by Google