Research progress of thoracolumbar injury classification systems_West China Medical Journal

Authors：

ZHOU Zhongjie ,  SONG Yueming

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SONG Yueming, Email: hx_sym@163.com

Keywords：

Thoracolumbar fracture; Classification; Spinal fracture

DOI：

10.7507/1002-0179.201908134

Video：

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Thoracolumbar fractures are common injuries. Accurate diagnosis and classification are of great significance for guiding treatment. Although there are many classification systems, they have not been universally accepted and used to guide clinical practice. Denis classification, load sharing classification, Magerl/AO classification, and Thoracolumbar Injury Classification and Severity Score have a great clinical influence, but they also have some shortcomings. Recently, some new classifications of thoracolumbar fractures have been proposed, and some of them have been updated and revised, which makes it easy to cause confusion, and puts forward new requirements on how to grasp and apply these classification systems. This article reviews the main and commonly used classification systems of thoracolumbar fractures, discusses the main viewpoints, advantages and disadvantages of each classification system, and looks ahead to the future research direction.

Citation： ZHOU Zhongjie, SONG Yueming. Research progress of thoracolumbar injury classification systems. West China Medical Journal, 2019, 34(9): 959-963. doi: 10.7507/1002-0179.201908134 Copy

1.	Wood KB, Buttermann GR, Phukan R, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am, 2015, 97(1): 3-9.
2.	Joaquim AF, Daubs MD, Lawrence BD, et al. Retrospective evaluation of the validity of the thoracolumbar injury classification system in 458 consecutively treated patients. Spine J, 2013, 13(12): 1760-1765.
3.	Joaquim AF, Patel AA. Relationships between the arbeitsgemeinschaft für osteosynthesefragen spine system and the thoracolumbar injury classification system: an analysis of the literature. J Spinal Cord Med, 2013, 36(6): 586-590.
4.	Magnusson E, Spina N, Fernando ND. Classifications in brief: the thoracolumbar injury classification. Clin Orthop Relat Res, 2018, 476(1): 160-166.
5.	Aebi M. AO spine classification system for thoracolumbar fractures. Eur Spine J, 2013, 22(10): 2147-2148.
6.	James KS, Wenger KH, Schlegel JD, et al. Biomechanical evaluation of the stability of thoracolumbar burst fractures. Spine (Phila Pa 1976), 1994, 19(15): 1731-1740.
7.	Ağuş H, Kayali C, Arslantaş M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients. Eur Spine J, 2005, 14(6): 536-540.
8.	Wood KB, Khanna G, Vaccaro AR, et al. Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons. J Bone Joint Surg Am, 2005, 87(7): 1423-1429.
9.	McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
10.	Parker JW, Lane JR, Karaikovic EE, et al. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976), 2000, 25(9): 1157-1170.
11.	Mattei TA, Hanovnikian J, H Dinh D. Progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the achilles tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS). Eur Spine J, 2014, 23(11): 2255-2262.
12.	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.
13.	Sethi MK, Schoenfeld AJ, Bono CM, et al. The evolution of thoracolumbar injury classification systems. Spine J, 2009, 9(9): 780-788.
14.	Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3(4): 184-201.
15.	Oner FC, van Gils AP, Dhert WJA, et al. MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures. Skeletal Radiol, 1999, 28(8): 433.
16.	Reinhold M, Audigé L, Schnake KJ, et al. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J, 2013, 22(10): 2184-2201.
17.	Vaccaro AR, Lehman RA, 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.
18.	Joaquim AF, Fernandes YB, Cavalcante RA, et al. Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma. Spine (Phila Pa 1976), 2011, 36(1): 33-36.
19.	Joaquim AF, Ghizoni E, Tedeschi H, et al. Clinical results of patients with thoracolumbar spine trauma treated according to the Thoracolumbar Injury Classification and Severity Score. J Neurosurg: Spine, 2014, 20(5): 562-567.
20.	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.
21.	Kepler CK, Vaccaro AR, Schroeder GD, et al. The thoracolumbar aospine injury score. Global Spine J, 2016, 6(4): 329-334.
22.	Schnake KJ. Expert’s comment concerning Grand Rounds case entitled " progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the achilles tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS)” (T.A. Mattei, J. Hanovnikian, D. Dinh). Eur Spine J, 2014, 23(11): 2263-2264.
23.	Pizones J, Álvarez-González P, Sánchez-Mariscal F, et al. Re: Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system. Fracture description, neurological status, and key modifiers. Spine 2013, 38: 2028-2037. Spine (Phila Pa 1976), 2014, 38(9): 783.
24.	Howard BM, Sribnick EA, Dhall SS. Complete neurologic recovery of spinal cord injury after posterior transpedicular reconstruction for traumatic lumbar burst fracture. Spine J, 2013, 13(2): 204-205.

1. Wood KB, Buttermann GR, Phukan R, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am, 2015, 97(1): 3-9.
2. Joaquim AF, Daubs MD, Lawrence BD, et al. Retrospective evaluation of the validity of the thoracolumbar injury classification system in 458 consecutively treated patients. Spine J, 2013, 13(12): 1760-1765.
3. Joaquim AF, Patel AA. Relationships between the arbeitsgemeinschaft für osteosynthesefragen spine system and the thoracolumbar injury classification system: an analysis of the literature. J Spinal Cord Med, 2013, 36(6): 586-590.
4. Magnusson E, Spina N, Fernando ND. Classifications in brief: the thoracolumbar injury classification. Clin Orthop Relat Res, 2018, 476(1): 160-166.
5. Aebi M. AO spine classification system for thoracolumbar fractures. Eur Spine J, 2013, 22(10): 2147-2148.
6. James KS, Wenger KH, Schlegel JD, et al. Biomechanical evaluation of the stability of thoracolumbar burst fractures. Spine (Phila Pa 1976), 1994, 19(15): 1731-1740.
7. Ağuş H, Kayali C, Arslantaş M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients. Eur Spine J, 2005, 14(6): 536-540.
8. Wood KB, Khanna G, Vaccaro AR, et al. Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons. J Bone Joint Surg Am, 2005, 87(7): 1423-1429.
9. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
10. Parker JW, Lane JR, Karaikovic EE, et al. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: a consecutive 41/2-year series. Spine (Phila Pa 1976), 2000, 25(9): 1157-1170.
11. Mattei TA, Hanovnikian J, H Dinh D. Progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the achilles tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS). Eur Spine J, 2014, 23(11): 2255-2262.
12. 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.
13. Sethi MK, Schoenfeld AJ, Bono CM, et al. The evolution of thoracolumbar injury classification systems. Spine J, 2009, 9(9): 780-788.
14. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3(4): 184-201.
15. Oner FC, van Gils AP, Dhert WJA, et al. MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures. Skeletal Radiol, 1999, 28(8): 433.
16. Reinhold M, Audigé L, Schnake KJ, et al. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J, 2013, 22(10): 2184-2201.
17. Vaccaro AR, Lehman RA, 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.
18. Joaquim AF, Fernandes YB, Cavalcante RA, et al. Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma. Spine (Phila Pa 1976), 2011, 36(1): 33-36.
19. Joaquim AF, Ghizoni E, Tedeschi H, et al. Clinical results of patients with thoracolumbar spine trauma treated according to the Thoracolumbar Injury Classification and Severity Score. J Neurosurg: Spine, 2014, 20(5): 562-567.
20. 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.
21. Kepler CK, Vaccaro AR, Schroeder GD, et al. The thoracolumbar aospine injury score. Global Spine J, 2016, 6(4): 329-334.
22. Schnake KJ. Expert’s comment concerning Grand Rounds case entitled " progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the achilles tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS)” (T.A. Mattei, J. Hanovnikian, D. Dinh). Eur Spine J, 2014, 23(11): 2263-2264.
23. Pizones J, Álvarez-González P, Sánchez-Mariscal F, et al. Re: Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system. Fracture description, neurological status, and key modifiers. Spine 2013, 38: 2028-2037. Spine (Phila Pa 1976), 2014, 38(9): 783.
24. Howard BM, Sribnick EA, Dhall SS. Complete neurologic recovery of spinal cord injury after posterior transpedicular reconstruction for traumatic lumbar burst fracture. Spine J, 2013, 13(2): 204-205.

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