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Spine Trauma Study Group Thoracolumbar Classification System Three Part Description

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Thoracolumbar Fracture Classification System A New Approach Spine Trauma Study Group Alexander R Vaccaro M.D. Professor - PowerPoint PPT Presentation


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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. Spine Trauma Study Group Thoracolumbar Classification System Three Part Description.

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Thoracolumbar FractureClassification SystemA New ApproachSpine Trauma Study GroupAlexander R Vaccaro M.D.ProfessorThomas Jefferson UniversityDepartment of Orthopaedicsand the Rothman Institute

spine trauma study group thoracolumbar classification system three part description
Spine Trauma Study GroupThoracolumbar Classification SystemThree Part Description

Fracture Description (Morphometric)

Neurologic Status

Integrity of PLC

fracture description morphology
Fracture Description (Morphology)
  • Compression-axial, flexion,distraction,translation/rotation
  • Distraction- extension,flexion,translation/rotation, compression
  • Translation/Rotation-flexion, distraction
neurologic status
Neurologic Status
  • Intact
  • Nerve Root Injury
  • Cauda Equina Injury
  • Cord Injury-Incomplete, Complete
posterior ligamentous complex
Posterior Ligamentous Complex
  • Intact
  • Disrupted In Tension
treatment determined by
TreatmentDetermined by:
  • Mechanism
  • Neurology
  • Ligament/ bone Integrity
mechanism point system
Mechanism-Point System

Two Component Mechanistic Description

Compression

1

Translation/

Rotation

3

Distraction

3

neurology point system
Neurology-Point System

Intact

0

Nerve root

Cauda equina

1

3

Cord

Incomplete

Complete

3

2

stability soft tissue point system
Stability-Soft Tissue Point System

Ligaments

Intact 0

PLC

Injured 3

Evaluated by MRI

stability spinal column point system
Stability Spinal Column Point System

Spinal Column

Anterior

Posterior

1

1

Middle

1

next step direct tx
Next Step - Direct TX

AssignPoints

Conservative

Surgery

point system
Point System

Ligament

Mechanism

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

treatment
Treatment
  • Fractures with 4 points or less = non operative
  • Fractures with 5 points=Nonop vs Op
  • Fractures with 6 points or more = surgery
examples anterior compression fx
ExamplesAnterior Compression Fx
  • Compression ( mechanism) - 1
  • Intact (neurology) - 0
  • PLC (ligament) no injury - 0
  • Anterior Column - 1

Total 2 points- Non Op

example stable burst fracture
ExampleStable Burst Fracture
  • Compression (mechanism) - 1
  • Intact ( neurology) - 0
  • PLC (ligament) no injury (0)
  • Ant/Middle column 1+1

Total 3 points-Non Op

example unstable burst complete neuro injury
ExampleUnstable Burst-Complete Neuro Injury
  • Compression (mechanism) -1
  • Complete (neurology) - 2
  • PLC (ligament) injury - 3
  • Ant/Middle column -1+1

Total 8 points-Surgery

example stable burst complete injury
ExampleStable Burst-Complete injury
  • Compression-1
  • Complete neurology-2
  • PLC Intact-0
  • Anterior, Middle Column disruption- 1+1

Points 5-Non Op vs Op

example fx dislocation
ExampleFx Dislocation
  • Translation/rotation - distraction (mechanism) - 3 + 3
  • Complete (neurology) - 2
  • PLC (ligament) injury - 3
  • Anterior column - 1

Total 12 points-Surgery

surgically indicated patients approach selection
Surgically Indicated PatientsApproach Selection

Neurology

Ligament Status

Modifiers

approach selection
Approach Selection

Neurologically Intact

Ligament Injury present

Posterior alone vs.

Anterior alone vs.

Combined

approach selection21
Approach Selection

Neurologically Incomplete

Ligament Injury

No

Yes

Combined vs

Anterior

Anterior

Modifier – Osteoporosis

Combined

approach selection22
Approach Selection

Neurologically Complete Injury

Posterior

thoracolumbar fracture classification system
Thoracolumbar Fracture Classification System
  • Point system to determine nonoperative vs operative treatment
  • Neurology, ligamentous status helps determine surgical approach
  • Validation necessary
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