Presentation on theme: "Classification of Thoracolumbar spine injuries"— Presentation transcript:
1 Classification of Thoracolumbar spine injuries Abdulaziz Alomar, MD, MSc FRCSCAssistant Professor and consultant Orthopaedic surgeon. KKUH, KSU
2 Historical Classification Systems SummaryCommentsNicollDifferentiates stable from unstable fracturesServes as a foundation for subsequent classification systemsHoldsworthModifies previous classification systems to include the mechanisms of injury and two-column theoryFails to appreciate some burst fracture instabilitiesKelly & WhitesidesRefines the two-column modelClassification guides treatment of neurologic deficitDenisDevelopment of the three-column modelThe middle column is the primary determinant of mechanical stability.Gertzbein et al.Suggests a posterior component, anterior component and body componentInvolves the vertebral body as itrelates to kyphosis.
3 DenisGoal: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 bodyMiddle 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 bodyPosterior column- includes the neural arch, facet joints and capsules, ligamentum flavum, and remaining ligamentious complexDenis F. Clin Orthop Relat Res. 1984
5 Denis: Middle-column concept Developed to define burst fracturemiddle 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, orSpinous process.
10 Denis- Major injuries Fracture dislocation type Shear type Flexion rotationFlexion distraction
11 Load Sharing Classification Created system in response to poor patient outcomes when the vertebral body sustained a disproportionately severe injuryClassification system grades:Amount of damaged vertebral bodySpread of the fragments in the fracture sightAmount of corrected kyphosisMcCormack 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 fractureCan 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 .
15 AO ClassificationBased on the review of 1445 consecutive thoracolumbar injuriesPrimarily based on pathomorphological criteriaCategories based on:Main mechanism of injuryPathomorphological uniformityPrognostic aspects regarding healing potentialMagerl et al. Eur Spine J
16 AO ClassificationClassification reflects progressive scale of morphological damage by which the degree of instability is determinedConsists of a grid for sub-grouping injuries into three types:A, B and CEvery type has three groups, each of which contains three subgroups with specificationsMagerl et al. Eur Spine J
17 AO ClassificationTypes have a fundamental injury pattern which is determined by the three most important mechanisms acting on the spineCompressionDistractionAxial torqueMagerl et al. Eur Spine J