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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


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Spine Trauma Study GroupThoracolumbar Classification SystemThree Part Description

Fracture Description (Morphometric)

Neurologic Status

Integrity of PLC


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Fracture Description (Morphology)

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

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

  • Translation/Rotation-flexion, distraction


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Neurologic Status

  • Intact

  • Nerve Root Injury

  • Cauda Equina Injury

  • Cord Injury-Incomplete, Complete


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Posterior Ligamentous Complex

  • Intact

  • Disrupted In Tension


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TreatmentDetermined by:

  • Mechanism

  • Neurology

  • Ligament/ bone Integrity


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Mechanism-Point System

Two Component Mechanistic Description

Compression

1

Translation/

Rotation

3

Distraction

3


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Neurology-Point System

Intact

0

Nerve root

Cauda equina

1

3

Cord

Incomplete

Complete

3

2


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Stability-Soft Tissue Point System

Ligaments

Intact 0

PLC

Injured 3

Evaluated by MRI


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Stability Spinal Column Point System

Spinal Column

Anterior

Posterior

1

1

Middle

1


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Next Step - Direct TX

AssignPoints

Conservative

Surgery


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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


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Treatment

  • Fractures with 4 points or less = non operative

  • Fractures with 5 points=Nonop vs Op

  • Fractures with 6 points or more = surgery


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ExamplesAnterior Compression Fx

  • Compression ( mechanism) - 1

  • Intact (neurology) - 0

  • PLC (ligament) no injury - 0

  • Anterior Column - 1

Total 2 points- Non Op


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ExampleStable Burst Fracture

  • Compression (mechanism) - 1

  • Intact ( neurology) - 0

  • PLC (ligament) no injury (0)

  • Ant/Middle column 1+1

Total 3 points-Non Op


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ExampleUnstable Burst-Complete Neuro Injury

  • Compression (mechanism) -1

  • Complete (neurology) - 2

  • PLC (ligament) injury - 3

  • Ant/Middle column -1+1

Total 8 points-Surgery


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ExampleStable Burst-Complete injury

  • Compression-1

  • Complete neurology-2

  • PLC Intact-0

  • Anterior, Middle Column disruption- 1+1

    Points 5-Non Op vs Op


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ExampleFx Dislocation

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

  • Complete (neurology) - 2

  • PLC (ligament) injury - 3

  • Anterior column - 1

Total 12 points-Surgery


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Surgically Indicated PatientsApproach Selection

Neurology

Ligament Status

Modifiers


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Approach Selection

Neurologically Intact

Ligament Injury present

Posterior alone vs.

Anterior alone vs.

Combined


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Approach Selection

Neurologically Incomplete

Ligament Injury

No

Yes

Combined vs

Anterior

Anterior

Modifier – Osteoporosis

Combined


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Approach Selection

Neurologically Complete Injury

Posterior


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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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