Thoracolumbar spine fracture classification

Involve only a part of a column and do not lead to acute instability (when not accompanied by major injuries). Includes:

1. fracture of the transverse process: usually neurologically intact except in two areas:

a) L4–5→lumbosacral plexus injuries (there may be associated with renal injuries, check U/A for blood)

b) T1–2→brachial plexus injuries

2. fracture of articular process or pars interarticularis

3. isolated fractures of the spinous process: in the TL spine: these are usually due to direct trauma. Often difficult to detect on plain X-ray

4. isolated laminar fracture: rare. Should be stable

The McAfee classification describes 6 main types of fractures 6). A simplified system with four categories follows


1)
Ferguson RL, Allen BL., Jr A mechanistic classification of thoracolumbar spine fractures. Clin Orthop. 1984;189:77–88.
2)
Chance QC. Note on a type of flexion fracture of the spine. Br J Radiol. 1948;21:452–453. doi: 10.1259/0007-1285-21-249-452.
3)
Gertzbein SD, Court-Brown CM. Flexion/distraction injuries of the lumbar spine. Mechanisms of injury and classification. Clin Orthop. 1988;227:52–60.
4)
Rennie W, Mitchell N. Flexion-distraction injuries of the thoracolumbar spine. J Bone Joint Surg Am. 1973;55:386–390.
5)
Smith WS, Kauter H. Patterns and mechanics of lumbar injuries associated with lap seat belts. J Bone Joint Surg Am. 1969;51:239–254.
6)
Chedid MK, Green C. A Review of the Management of Lumbar Fractures With Focus on Surgical Decision-Making and Techniques. Contemp Neurosurg. 1999; 21:1–5
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