Thoracolumbar spinal fracture classification systems
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Thoracolumbar spinal fracture classification systems are numerous and represent attempts by various authors to create systems that allow uniform and reproducible classification and description of thoracolumbar fractures which in turn can help with treatment decision making and prognostication.
Despite numerous systems being proposed over the past century no universally accepted and clinically implemented system has yet been devised 2.
The two most commonly used systems are:
- AO classification of thoracolumbar injuries
- thoracolumbar injury classification and severity score (TLICS)
Each has benefits and drawbacks and each incorporates various features of prior systems in an attempt to classify thoracolumbar fractures in a clinically meaningful way.
As always, it is not so much a question of which is 'best' but rather which is most suited to accurate communication between members of the treating team.
Other classification systems that introduced important terminology still used in clinical practice include 2,3:
- three column concept of thoracolumbar spinal fractures (Denis classification, 1983)
- McAfee classification (1983)
- Magerl classification (original AO classification, 1994)
- 1. Bonfante, E.; Tenreiro, A.; Choi, J.; Supsupin, E.; Riascos, R. "Thoracolumbar Spine Trauma: Pearls and Pitfalls of the Newer Classification Systems" Neurographics, Volume 8, Number 2, 1 April 2018, pp. 86-96(11) DOI: 10.3174/ng.1600043. Full text PDF here
- 2. Jiménez-Almonte JH, King JD, Luo TD, Cassidy RC, Aneja A. Classifications in Brief: Thoracolumbar Injury Classification and Injury Severity Score System. (2018) Clinical orthopaedics and related research. 476 (6): 1352-1358. doi:10.1007/s11999.0000000000000088 - Pubmed
- 3. Reinhold M, Audigé L, Schnake KJ, Bellabarba C, Dai LY, Oner FC. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. (2013) European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 22 (10): 2184-201. doi:10.1007/s00586-013-2738-0 - Pubmed