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Spine Trauma Study Group Thoracolumbar Classification System Three Part Description

Thoracolumbar Fracture Classification System A New Approach Spine Trauma Study Group Alexander R Vaccaro M.D. Professor Thomas Jefferson University Department of Orthopaedics and the Rothman Institute. Spine Trauma Study Group Thoracolumbar Classification System Three Part Description.

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Spine Trauma Study Group Thoracolumbar Classification System Three Part Description

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  1. Thoracolumbar FractureClassification SystemA New ApproachSpine Trauma Study GroupAlexander R Vaccaro M.D.ProfessorThomas Jefferson UniversityDepartment of Orthopaedicsand the Rothman Institute

  2. Spine Trauma Study GroupThoracolumbar Classification SystemThree Part Description Fracture Description (Morphometric) Neurologic Status Integrity of PLC

  3. Fracture Description (Morphology) • Compression-axial, flexion,distraction,translation/rotation • Distraction- extension,flexion,translation/rotation, compression • Translation/Rotation-flexion, distraction

  4. Neurologic Status • Intact • Nerve Root Injury • Cauda Equina Injury • Cord Injury-Incomplete, Complete

  5. Posterior Ligamentous Complex • Intact • Disrupted In Tension

  6. TreatmentDetermined by: • Mechanism • Neurology • Ligament/ bone Integrity

  7. Mechanism-Point System Two Component Mechanistic Description Compression 1 Translation/ Rotation 3 Distraction 3

  8. Neurology-Point System Intact 0 Nerve root Cauda equina 1 3 Cord Incomplete Complete 3 2

  9. Stability-Soft Tissue Point System Ligaments Intact 0 PLC Injured 3 Evaluated by MRI

  10. Stability Spinal Column Point System Spinal Column Anterior Posterior 1 1 Middle 1

  11. Next Step - Direct TX AssignPoints Conservative Surgery

  12. Point System Ligament Mechanism Translation/Rotation - 3 PLC - 3 Distraction - 3 Compression - 1 Neurology Spinal Column Cauda equina - 3 Anterior - 1 Incomplete - 3 Middle - 1 Complete - 2 Posterior - 1 Root - 1

  13. Treatment • Fractures with 4 points or less = non operative • Fractures with 5 points=Nonop vs Op • Fractures with 6 points or more = surgery

  14. ExamplesAnterior Compression Fx • Compression ( mechanism) - 1 • Intact (neurology) - 0 • PLC (ligament) no injury - 0 • Anterior Column - 1 Total 2 points- Non Op

  15. ExampleStable Burst Fracture • Compression (mechanism) - 1 • Intact ( neurology) - 0 • PLC (ligament) no injury (0) • Ant/Middle column 1+1 Total 3 points-Non Op

  16. ExampleUnstable Burst-Complete Neuro Injury • Compression (mechanism) -1 • Complete (neurology) - 2 • PLC (ligament) injury - 3 • Ant/Middle column -1+1 Total 8 points-Surgery

  17. ExampleStable Burst-Complete injury • Compression-1 • Complete neurology-2 • PLC Intact-0 • Anterior, Middle Column disruption- 1+1 Points 5-Non Op vs Op

  18. ExampleFx Dislocation • Translation/rotation - distraction (mechanism) - 3 + 3 • Complete (neurology) - 2 • PLC (ligament) injury - 3 • Anterior column - 1 Total 12 points-Surgery

  19. Surgically Indicated PatientsApproach Selection Neurology Ligament Status Modifiers

  20. Approach Selection Neurologically Intact Ligament Injury present Posterior alone vs. Anterior alone vs. Combined

  21. Approach Selection Neurologically Incomplete Ligament Injury No Yes Combined vs Anterior Anterior Modifier – Osteoporosis Combined

  22. Approach Selection Neurologically Complete Injury Posterior

  23. Thoracolumbar Fracture Classification System • Point system to determine nonoperative vs operative treatment • Neurology, ligamentous status helps determine surgical approach • Validation necessary

  24. Thank You

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