Presentation on theme: "Classification of Thoracolumbar spine injuries Abdulaziz Alomar, MD, MSc FRCSC Assistant Professor and consultant Orthopaedic surgeon. KKUH, KSU."— Presentation transcript:
Classification of Thoracolumbar spine injuries Abdulaziz Alomar, MD, MSc FRCSC Assistant Professor and consultant Orthopaedic surgeon. KKUH, KSU
Historical Classification Systems SystemSummaryComments 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.
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.
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
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.
Isolated fractures of –Transverse process. –Articular process. –pars interarticularis, or –Spinous process. Denis- Minor injuries
Denis- Major injuries Compression type
Denis- Major injuries Burst Type E
Seat belt type Denis- Major injuries
Fracture dislocation type Denis- Major injuries Flexion rotationFlexion distraction Shear type
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
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.
Load sharing classification
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
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
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
AO Classification Type A(compression)
AO Classification Type B (Distraction)
AO Classification Type C (Torsion)
Examples of AO Classification
Summary Currently no classification system that has achieved global clinical utility and acceptance.