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

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

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

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

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

6. Where´s the fresh osteoporotic # ?!
TIRM T2w
TSE T1w
TYPE A ?

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

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

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

10. AVOID PITFALL If Type A injury is diagnosed, always assume injury
to posterior column:
1. Check history for any distraction/hyperflexion injury
TYPE B
2. Clinical Signs of posterior injury
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
4. If available or in doubt, go for MRI

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
TYPE B
PITFALL
Discoligamentous injury w/o
signs of vertebral fracture

13. Type B3: Anterior Distraction
=> Characteristic injury mechanism

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

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

16. AVOID PITFALL Check history for any rotational
injury (insufficient data, in most cases)
2. Rule out intraabdominal injury: Rotation can
lacerate mesenteric trunc or Pancreas
=> Abdominal Exam, Ultrasound, CT
TYPE C
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

17. Stable Type A Fracture ?!
TYPE C

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

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

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

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

22. Thank You