1. Thoracolumbar Fracture Classification System A New Approach Spine Trauma Study Group Alexander R Vaccaro M.D. Professor Thomas Jefferson University Department of Orthopaedics and the Rothman Institute

2. Fracture Description (Morphometric)
Spine Trauma Study Group Thoracolumbar Classification System Three Part Description
Fracture Description (Morphometric)
Neurologic Status
Integrity of PLC

3. Fracture Description (Morphology)
Compression-axial, flexion,distraction,translation/rotation
Distraction extension,flexion,translation/rotation, compression
Translation/Rotation-flexion, distraction

4. Neurologic Status Intact Nerve Root Injury Cauda Equina Injury
Cord Injury-Incomplete, Complete

5. Posterior Ligamentous Complex
Intact
Disrupted In Tension

6. Treatment Determined by:
Mechanism
Neurology
Ligament/ bone Integrity

7. Mechanism-Point System
Two Component Mechanistic Description
Compression 1
Translation /
Rotation 3
Distraction 3

8. Neurology-Point System
Intact
Nerve root
Cauda equina 1 3
Cord
Incomplete
Complete 3 2

9. Stability-Soft Tissue Point System
Ligaments
Intact 0
PLC
Injured 3
Evaluated by MRI

10. Stability Spinal Column Point System
Anterior
Posterior 1 1
Middle 1

11. Next Step - Direct TX
Assign Points
Conservative
Surgery

12. Translation/Rotation - 3
Point System
Mechanism
Ligament
Translation/Rotation - 3
PLC - 3
Distraction - 3
Compression - 1
Neurology
Spinal Column
Cauda equina - 3
Anterior - 1
Incomplete - 3
Middle - 1
Complete - 2
Posterior - 1
Root - 1

13. Treatment Fractures with 4 points or less = non operative
Fractures with 5 points=Nonop vs Op
Fractures with 6 points or more = surgery

14. Examples Anterior Compression Fx
Compression ( mechanism) - 1
Intact (neurology) - 0
PLC (ligament) no injury - 0
Anterior Column - 1
Total 2 points- Non Op

15. Example Stable Burst Fracture
Compression (mechanism) - 1
Intact ( neurology) - 0
PLC (ligament) no injury (0)
Ant/Middle column 1+1
Total 3 points-Non Op

16. Example Unstable Burst-Complete Neuro Injury
Compression (mechanism) -1
Complete (neurology) - 2
PLC (ligament) injury - 3
Ant/Middle column -1+1
Total 8 points-Surgery

17. Example Stable Burst-Complete injury
Compression-1
Complete neurology-2
PLC Intact-0
Anterior, Middle Column disruption- 1+1
Points 5-Non Op vs Op

18. Example Fx Dislocation
Translation/rotation - distraction (mechanism)
Complete (neurology) - 2
PLC (ligament) injury - 3
Anterior column - 1
Total 12 points-Surgery

19. Surgically Indicated Patients Approach Selection
Neurology
Ligament Status
Modifiers

20. Approach Selection Posterior alone vs. Neurologically Intact
Ligament Injury present
Posterior alone vs.
Anterior alone vs.
Combined

21. Approach Selection Combined vs Neurologically Incomplete
Ligament Injury No
Yes
Combined vs
Anterior
Anterior
Modifier – Osteoporosis
Combined

22. Approach Selection
Neurologically Complete Injury
Posterior

23. Thoracolumbar Fracture Classification System
Point system to determine nonoperative vs operative treatment
Neurology, ligamentous status helps determine surgical approach
Validation necessary

24. Thank You