Research progress of thoracolumbar injury classification systems_West China Medical Journal

Authors：

YANG Sheng ,  LI Haibo , GOU Yongsheng , XU Shengxi , GONG Dezhi

Department of Orthopedics, West China (Airport) Hospital Sichuan University, the First Peoples Hospital of Shuangliu District, Chengdu, Sichuan 610200, P. R. China;

Corresponding?author：

LI Haibo, Email: haibo1964@163.com

Keywords：

Thoracolumbar injury; classification; spinal fracture

DOI：

10.7507/1002-0179.202109040

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Thoracolumbar injury is a common injury in clinic. Accurate diagnosis and classification is of great significance for guiding treatment. Although there are many typing systems, no typing system has been widely accepted and used to guide clinical practice. Denis classification, spinal load classification, thoracolumbar injury classification system and severity score or thoracolumbar injury classification and severity score and AO classification have great influence in clinical practice, but they all have some shortcomings. In recent years, the classification of thoracolumbar injury has been updated, modified and supplemented constantly. When using these fracture types in clinical practice, different people often have some deviation. This paper reviews the widely used thoracolumbar injury classification system, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks into the future research direction based on the current research progress.

Citation： YANG Sheng, LI Haibo, GOU Yongsheng, XU Shengxi, GONG Dezhi. Research progress of thoracolumbar injury classification systems. West China Medical Journal, 2022, 37(10): 1549-1553. doi: 10.7507/1002-0179.202109040 Copy

1.	趙正琦, 孫先澤, 任亮, 等. 后路單間隙融合雙節段固定治療 Denis B 型胸腰椎爆裂性骨折. 中國矯形外科雜志, 2012, 20(20): 1825-1828.
2.	Vaccaro AR, Zeiller SC, Hulbert RJ, et al. The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech, 2005, 18(3): 209-215.
3.	王延斌, 謝偉勇, 蒲志超, 等. 胸腰椎爆裂性骨折早期前后路手術治療臨床療效觀察. 武警后勤學院學報(醫學版), 2012, 21(9): 685-687.
4.	張光鉑. 淺談脊柱內固定的應用與植骨融合. 中國脊柱脊髓雜志, 2002, 12(5): 325.
5.	Magnusson E, Spina N, Fernando ND. Classifications in brief: the thoracolumbar injury classification. Clin Orthop Relat Res, 2018, 476(1): 160-166.
6.	Watson-Jones R. The results of postural reduction of fractures of the spine. J Bone Joint Surg Am, 1938, 20(3): 567-586.
7.	Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br, 1949, 31B(3): 376-394.
8.	Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am, 1970, 52(8): 1534-1551.
9.	Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
10.	McAfee PC, Yuan HA, Fredrickson BE, et al. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am, 1983, 65(4): 461-473.
11.	McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
12.	Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
13.	Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976), 2005, 30(20): 2325-2333.
14.	Machino M, Yukawa Y, Ito K, et al. The complement of the load-sharing classification for the thoracolumbar injury classification system in managing thoracolumbar burst fractures. J Orthop Sci, 2013, 18(1): 81-86.
15.	Lewkonia P, Paolucci EO, Thomas K. Reliability of the thoracolumbar injury classification and severity score and comparison with the denis classification for injury to the thoracic and lumbar spine. Spine (Phila Pa 1976), 2012, 37(26): 2161-2167.
16.	van Middendorp JJ, Patel AA, Schuetz M, et al. The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature. Eur Spine J, 2013, 22(3): 461-474.
17.	Pneumaticos SG, Triantafyllopoulos GK, Giannoudis PV. Advances made in the treatment of thoracolumbar fractures: current trends and future direction. Injury, 2013, 44(6): 703-712.
18.	Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976), 2013, 38(23): 2028-2037.
19.	何玉寶, 徐執揚, 任龍喜, 等. TLICS 和 AO-TLICS 評分在臨床中應用的對比研究. 國際外科學雜志, 2019, 46(7): 465-470.
20.	Kepler CK, Vaccaro AR, Schroeder GD, et al. The thoracolumbar AOSpine injury score. Global Spine J, 2016, 6(4): 329-334.
21.	Santander XA, Rodríguez-Boto G. Retrospective evaluation of thoracolumbar injury classification system and thoracolumbar ao spine injury scores for the decision treatment of thoracolumbar traumatic fractures in 458 consecutive patients. World Neurosurg, 2021, 153: e446-e453.
22.	Mariotti AJ, Diwan AD. Current concepts in anterior surgery for thoracolumbar trauma. Orthop Clin North Am, 2002, 33(2): 403-412.
23.	Yang M, Ding GZ, Xu ZJ. Surgical outcome in thoracolumbar fractures managed by short-segment pedicle instrumentation. Ann Acad Med Singap, 2014, 43(1): 24-32.
24.	王想福, 王興盛. Wiltse 入路經椎弓根植骨治療胸腰椎骨折. 中國骨傷, 2013, 26(7): 587-590.
25.	沈斐, 潘文明, 王筱林, 等. 兩種不同入路治療無神經癥狀胸腰椎骨折的病例對照研究. 中國骨傷, 2012, 25(4): 303-305.
26.	Vaccaro AR, Kim DH, Brodke DS, et al. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect, 2004, 53: 359-373.
27.	Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit . A prospective, randomized study. J Bone Joint Surg Am, 2003, 85(5): 773-781.
28.	Gertzbein SD, Crowe PJ, Fazl M, et a1. Canal clearance in burst fractures using the AO internal fixator. Spine (Phila Pa 1976), 1992, 17(5): 558-560.
29.	Kong W, Sun Y, Hu J, et al. Modified posterior decompression for the management of thoracolumbar burst fractures with canal encroachment. J Spinal Disord Tech, 2010, 23(5): 302-309.
30.	魏富鑫, 崔尚斌, 李廣勝, 等. 單、雙運動單元固定治療胸腰椎骨折的療效比較. 中華骨科雜志, 2012, 32(4): 309-316.
31.	唐剛, 江建明, 翟東濱, 等. 后路經傷椎椎弓根螺釘固定在胸腰椎骨折治療中的應用. 中國骨與關節損傷雜志, 2010, 25(3): 228-229.
32.	李鵬飛, 房根強, 李華, 等. 胸腰椎壓縮骨折復位術中傷椎植釘曲度矯正的臨床意義. 中國修復重建外科雜志, 2013, 27(2): 135-139.
33.	Fisher SC, Shores A, Simpson ST. Constrictive myelopathy secondary to hypoplasia or aplasia of the thoracolumbar caudal articular processes in pugs: 11 cases (1993-2009). J Am Vet Med Assoc, 2013, 242(2): 223-229.
34.	Shang J, Ling XD, Liu YC, et al. Biomechanical effects of pedicle screw adjustments on the thoracolumbar burst fractures. Chin Med J (Engl), 2013, 126(2): 300-305.
35.	何建華, 馮大雄. 后路內固定融合術治療不同分型胸腰椎骨折的臨床療效. 中國脊柱脊髓雜志, 2016, 26(7): 596-601.
36.	Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fracture. Spine J, 2014, 14(1): 145-164.
37.	梅啟元, 邵琳. 椎弓根內固定聯合不同融合方式治療峽部裂型腰椎滑脫癥效果比較. 解放軍醫藥雜志, 2017, 29(4): 78-81.
38.	Baumann F, Krutsch W, Pfeifer C, et al. Posterolateral fusion in acute traumatic thoracolumbar fractures: a comparison of demineralized bone matrix and autologous bone graft. Acta Chir Orthop Traumatol Cech, 2015, 82(2): 119-125.

1. 趙正琦, 孫先澤, 任亮, 等. 后路單間隙融合雙節段固定治療 Denis B 型胸腰椎爆裂性骨折. 中國矯形外科雜志, 2012, 20(20): 1825-1828.
2. Vaccaro AR, Zeiller SC, Hulbert RJ, et al. The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech, 2005, 18(3): 209-215.
3. 王延斌, 謝偉勇, 蒲志超, 等. 胸腰椎爆裂性骨折早期前后路手術治療臨床療效觀察. 武警后勤學院學報(醫學版), 2012, 21(9): 685-687.
4. 張光鉑. 淺談脊柱內固定的應用與植骨融合. 中國脊柱脊髓雜志, 2002, 12(5): 325.
5. Magnusson E, Spina N, Fernando ND. Classifications in brief: the thoracolumbar injury classification. Clin Orthop Relat Res, 2018, 476(1): 160-166.
6. Watson-Jones R. The results of postural reduction of fractures of the spine. J Bone Joint Surg Am, 1938, 20(3): 567-586.
7. Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br, 1949, 31B(3): 376-394.
8. Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am, 1970, 52(8): 1534-1551.
9. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976), 1983, 8(8): 817-831.
10. McAfee PC, Yuan HA, Fredrickson BE, et al. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am, 1983, 65(4): 461-473.
11. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
12. Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech, 2010, 23(5): 293-301.
13. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976), 2005, 30(20): 2325-2333.
14. Machino M, Yukawa Y, Ito K, et al. The complement of the load-sharing classification for the thoracolumbar injury classification system in managing thoracolumbar burst fractures. J Orthop Sci, 2013, 18(1): 81-86.
15. Lewkonia P, Paolucci EO, Thomas K. Reliability of the thoracolumbar injury classification and severity score and comparison with the denis classification for injury to the thoracic and lumbar spine. Spine (Phila Pa 1976), 2012, 37(26): 2161-2167.
16. van Middendorp JJ, Patel AA, Schuetz M, et al. The precision, accuracy and validity of detecting posterior ligamentous complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature. Eur Spine J, 2013, 22(3): 461-474.
17. Pneumaticos SG, Triantafyllopoulos GK, Giannoudis PV. Advances made in the treatment of thoracolumbar fractures: current trends and future direction. Injury, 2013, 44(6): 703-712.
18. Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976), 2013, 38(23): 2028-2037.
19. 何玉寶, 徐執揚, 任龍喜, 等. TLICS 和 AO-TLICS 評分在臨床中應用的對比研究. 國際外科學雜志, 2019, 46(7): 465-470.
20. Kepler CK, Vaccaro AR, Schroeder GD, et al. The thoracolumbar AOSpine injury score. Global Spine J, 2016, 6(4): 329-334.
21. Santander XA, Rodríguez-Boto G. Retrospective evaluation of thoracolumbar injury classification system and thoracolumbar ao spine injury scores for the decision treatment of thoracolumbar traumatic fractures in 458 consecutive patients. World Neurosurg, 2021, 153: e446-e453.
22. Mariotti AJ, Diwan AD. Current concepts in anterior surgery for thoracolumbar trauma. Orthop Clin North Am, 2002, 33(2): 403-412.
23. Yang M, Ding GZ, Xu ZJ. Surgical outcome in thoracolumbar fractures managed by short-segment pedicle instrumentation. Ann Acad Med Singap, 2014, 43(1): 24-32.
24. 王想福, 王興盛. Wiltse 入路經椎弓根植骨治療胸腰椎骨折. 中國骨傷, 2013, 26(7): 587-590.
25. 沈斐, 潘文明, 王筱林, 等. 兩種不同入路治療無神經癥狀胸腰椎骨折的病例對照研究. 中國骨傷, 2012, 25(4): 303-305.
26. Vaccaro AR, Kim DH, Brodke DS, et al. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect, 2004, 53: 359-373.
27. Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit . A prospective, randomized study. J Bone Joint Surg Am, 2003, 85(5): 773-781.
28. Gertzbein SD, Crowe PJ, Fazl M, et a1. Canal clearance in burst fractures using the AO internal fixator. Spine (Phila Pa 1976), 1992, 17(5): 558-560.
29. Kong W, Sun Y, Hu J, et al. Modified posterior decompression for the management of thoracolumbar burst fractures with canal encroachment. J Spinal Disord Tech, 2010, 23(5): 302-309.
30. 魏富鑫, 崔尚斌, 李廣勝, 等. 單、雙運動單元固定治療胸腰椎骨折的療效比較. 中華骨科雜志, 2012, 32(4): 309-316.
31. 唐剛, 江建明, 翟東濱, 等. 后路經傷椎椎弓根螺釘固定在胸腰椎骨折治療中的應用. 中國骨與關節損傷雜志, 2010, 25(3): 228-229.
32. 李鵬飛, 房根強, 李華, 等. 胸腰椎壓縮骨折復位術中傷椎植釘曲度矯正的臨床意義. 中國修復重建外科雜志, 2013, 27(2): 135-139.
33. Fisher SC, Shores A, Simpson ST. Constrictive myelopathy secondary to hypoplasia or aplasia of the thoracolumbar caudal articular processes in pugs: 11 cases (1993-2009). J Am Vet Med Assoc, 2013, 242(2): 223-229.
34. Shang J, Ling XD, Liu YC, et al. Biomechanical effects of pedicle screw adjustments on the thoracolumbar burst fractures. Chin Med J (Engl), 2013, 126(2): 300-305.
35. 何建華, 馮大雄. 后路內固定融合術治療不同分型胸腰椎骨折的臨床療效. 中國脊柱脊髓雜志, 2016, 26(7): 596-601.
36. Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fracture. Spine J, 2014, 14(1): 145-164.
37. 梅啟元, 邵琳. 椎弓根內固定聯合不同融合方式治療峽部裂型腰椎滑脫癥效果比較. 解放軍醫藥雜志, 2017, 29(4): 78-81.
38. Baumann F, Krutsch W, Pfeifer C, et al. Posterolateral fusion in acute traumatic thoracolumbar fractures: a comparison of demineralized bone matrix and autologous bone graft. Acta Chir Orthop Traumatol Cech, 2015, 82(2): 119-125.

West China Medical Journal

Research progress of thoracolumbar injury classification systems

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content