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：

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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.	赵正琦, 孙先泽, 任亮, 等. 后路单间隙融合双节段固定治疗 Denis B 型胸腰椎爆裂性骨折. 中国矫形外科杂志, 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, 谢伟勇, 蒲志超, 等. 胸腰椎爆裂性骨折早期前后路手术治疗临床疗效观察. 武警后勤学院学报(医学版), 2012, 21(9): 685-687.
4.	张光铂. 浅谈脊柱内固定的应用与植骨融合. 中国脊柱脊髓杂志, 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.	何玉宝, 徐执扬, 任龙喜, 等. TLICS 和 AO-TLICS 评分在临床中应用的对比研究. 国际外科学杂志, 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, 王兴盛. Wiltse 入路经椎弓根植骨治疗胸腰椎骨折. 中国骨伤, 2013, 26(7): 587-590.
25.	沈斐, 潘文明, 王筱林, 等. 两种不同入路治疗无神经症状胸腰椎骨折的病例对照研究. 中国骨伤, 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, 李广胜, 等. 单、双运动单元固定治疗胸腰椎骨折的疗效比较. 中华骨科杂志, 2012, 32(4): 309-316.
31.	唐刚, 江建明, 翟东滨, 等. 后路经伤椎椎弓根螺钉固定在胸腰椎骨折治疗中的应用. 中国骨与关节损伤杂志, 2010, 25(3): 228-229.
32.	李鹏飞, 房根强, 李华, 等. 胸腰椎压缩骨折复位术中伤椎植钉曲度矫正的临床意义. 中国修复重建外科杂志, 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.	何建华, 冯大雄. 后路内固定融合术治疗不同分型胸腰椎骨折的临床疗效. 中国脊柱脊髓杂志, 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.	梅启元, 邵琳. 椎弓根内固定联合不同融合方式治疗峡部裂型腰椎滑脱症效果比较. 解放军医药杂志, 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. 赵正琦, 孙先泽, 任亮, 等. 后路单间隙融合双节段固定治疗 Denis B 型胸腰椎爆裂性骨折. 中国矫形外科杂志, 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, 谢伟勇, 蒲志超, 等. 胸腰椎爆裂性骨折早期前后路手术治疗临床疗效观察. 武警后勤学院学报(医学版), 2012, 21(9): 685-687.
4. 张光铂. 浅谈脊柱内固定的应用与植骨融合. 中国脊柱脊髓杂志, 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. 何玉宝, 徐执扬, 任龙喜, 等. TLICS 和 AO-TLICS 评分在临床中应用的对比研究. 国际外科学杂志, 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, 王兴盛. Wiltse 入路经椎弓根植骨治疗胸腰椎骨折. 中国骨伤, 2013, 26(7): 587-590.
25. 沈斐, 潘文明, 王筱林, 等. 两种不同入路治疗无神经症状胸腰椎骨折的病例对照研究. 中国骨伤, 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, 李广胜, 等. 单、双运动单元固定治疗胸腰椎骨折的疗效比较. 中华骨科杂志, 2012, 32(4): 309-316.
31. 唐刚, 江建明, 翟东滨, 等. 后路经伤椎椎弓根螺钉固定在胸腰椎骨折治疗中的应用. 中国骨与关节损伤杂志, 2010, 25(3): 228-229.
32. 李鹏飞, 房根强, 李华, 等. 胸腰椎压缩骨折复位术中伤椎植钉曲度矫正的临床意义. 中国修复重建外科杂志, 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. 何建华, 冯大雄. 后路内固定融合术治疗不同分型胸腰椎骨折的临床疗效. 中国脊柱脊髓杂志, 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. 梅启元, 邵琳. 椎弓根内固定联合不同融合方式治疗峡部裂型腰椎滑脱症效果比较. 解放军医药杂志, 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

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