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Spine Trauma Study Group Thoracolumbar Classification System Three Part Description 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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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 GroupThoracolumbar Classification SystemThree Part Description

Fracture Description (Morphometric)

Neurologic Status

Integrity of PLC


Fracture Description (Morphology)

  • Compression-axial, flexion,distraction,translation/rotation

  • Distraction- extension,flexion,translation/rotation,compression

  • Translation/Rotation-flexion, distraction


Neurologic Status

  • Intact

  • Nerve Root Injury

  • Cauda Equina Injury

  • Cord Injury-Incomplete, Complete


Posterior Ligamentous Complex

  • Intact

  • Disrupted In Tension


TreatmentDetermined by:

  • Mechanism

  • Neurology

  • Ligament/ bone Integrity


Mechanism-Point System

Two Component Mechanistic Description

Compression

1

Translation/

Rotation

3

Distraction

3


Neurology-Point System

Intact

0

Nerve root

Cauda equina

1

3

Cord

Incomplete

Complete

3

2


Stability-Soft Tissue Point System

Ligaments

Intact 0

PLC

Injured 3

Evaluated by MRI


Stability Spinal Column Point System

Spinal Column

Anterior

Posterior

1

1

Middle

1


Next Step - Direct TX

AssignPoints

Conservative

Surgery


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

  • Fractures with 4 points or less = non operative

  • Fractures with 5 points=Nonop vs Op

  • Fractures with 6 points or more = surgery


ExamplesAnterior Compression Fx

  • Compression ( mechanism) - 1

  • Intact (neurology) - 0

  • PLC (ligament) no injury - 0

  • Anterior Column - 1

Total 2 points- Non Op


ExampleStable Burst Fracture

  • Compression (mechanism) - 1

  • Intact ( neurology) - 0

  • PLC (ligament) no injury (0)

  • Ant/Middle column 1+1

Total 3 points-Non Op


ExampleUnstable Burst-Complete Neuro Injury

  • Compression (mechanism) -1

  • Complete (neurology) - 2

  • PLC (ligament) injury - 3

  • Ant/Middle column -1+1

Total 8 points-Surgery


ExampleStable Burst-Complete injury

  • Compression-1

  • Complete neurology-2

  • PLC Intact-0

  • Anterior, Middle Column disruption- 1+1

    Points 5-Non Op vs Op


ExampleFx Dislocation

  • Translation/rotation - distraction (mechanism) - 3 + 3

  • Complete (neurology) - 2

  • PLC (ligament) injury - 3

  • Anterior column - 1

Total 12 points-Surgery


Surgically Indicated PatientsApproach Selection

Neurology

Ligament Status

Modifiers


Approach Selection

Neurologically Intact

Ligament Injury present

Posterior alone vs.

Anterior alone vs.

Combined


Approach Selection

Neurologically Incomplete

Ligament Injury

No

Yes

Combined vs

Anterior

Anterior

Modifier – Osteoporosis

Combined


Approach Selection

Neurologically Complete Injury

Posterior


Thoracolumbar Fracture Classification System

  • Point system to determine nonoperative vs operative treatment

  • Neurology, ligamentous status helps determine surgical approach

  • Validation necessary


Thank You


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