Copyright
©The Author(s) 2015.
World J Radiol. Sep 28, 2015; 7(9): 253-265
Published online Sep 28, 2015. doi: 10.4329/wjr.v7.i9.253
Published online Sep 28, 2015. doi: 10.4329/wjr.v7.i9.253
Table 1 Subcategories of AO type A injury
| Type A: Vertebral body compression |
| A1. Impaction fractures |
| A1.1. Endplate impaction |
| A1.2. Wedge impaction fractures |
| A1.2.1. Superior wedge impaction fracture |
| A1.2.2. Lateral wedge impaction fracture |
| A1.2.3. Inferior wedge impaction fracture |
| A1.3. Vertebral body collapse |
| A2. Split fractures |
| A2.1. Sagittal split fracture |
| A2.2. Coronal split fracture |
| A2.3. Pincer fracture |
| A3. Burst fractures |
| A3.1. Incomplete burst fracture |
| A3.1.1. Superior incomplete burst fracture |
| A3.1.2. Lateral incomplete burst fracture |
| A3.1.3. Inferior incomplete burst fracture |
| A3.2. Burst-split fracture |
| A3.2.1. Superior burst-split fracture |
| A3.2.2. Lateral burst-split fracture |
| A3.2.3. Inferior burst-split fracture |
| A3.3. Complete burst fracture |
| A3.3.1. Pincer burst fracture |
| A3.3.2. Complete flexion burst fracture |
| A3.3.3. Complete axial burst fracture |
Table 2 Subcategories of AO type B injury
| Type B: Anterior and posterior element injury with distraction |
| B1. Posterior disruption predominantly ligamentous (flexion-distraction injury) |
| B1.1. With transverse disruption of the disc |
| B1.1.1. Flexion-subluxation |
| B1.1.2. Anterior dislocation |
| B1.1.3. Flexion-subluxation/anterior dislocation with fracture of the articular processes |
| B1.2. With type A fracture of the vertebral body |
| B1.2.1. Flexion-subluxation + type A fracture |
| B1.2.2. Anterior dislocation + type A fracture |
| B1.2.3. Flexion-subluxation/anterior dislocation with fracture of the articular processes + type A fracture |
| B2. Posterior disruption predominantly osseous (flexion-distraction injury) |
| B2.1. Transverse bicolumn fracture |
| B2.2. With transverse disruption of the disc |
| B2.2.1. Disruption through the pedicle and disc |
| B2.2.2. Disruption through the parsinterarticularis and disc (flexion- spondylolysis) |
| B2.3. With type A fracture of the vertebral body |
| B2.3.1. Fracture through the pedicle + type A fracture |
| B2.3.2. Fracture through the parsinterarticularis (flexion-spondylolysis) + type A fracture |
| B3. Anterior disruption through the disc (hyperextension-shear injury) |
| B3.1. Hyperextension-subluxations |
| B3.1.1. Without injury of the posterior column |
| B3.1.2. With injury of the posterior column |
| B3.2. Hyperextension-spondylolysis |
| B3.3. Posterior dislocation |
Table 3 Subcategories of AO type C injury
| Type C: Anterior and posterior element injury with rotation |
| C1. Type A injuries with rotation(compression injuries with rotation) |
| C1.1. Rotational wedge fracture |
| C1.2. Rotational split fractures |
| C1.2.1. Rotational sagittal split fracture |
| C1.2.2. Rotational coronal split fracture |
| C1.2.3. Rotational pincer fracture |
| C1.2.4. Vertebral body separation |
| C1.3. Rotational burst fractures |
| C1.3.1. Incomplete rotational burst fractures |
| C1.3.2. Rotational burst-split fracture |
| C1.3.3. Complete rotational burst fracture |
| C2. Type B injuries with rotation |
| C2.1. B1 injuries with rotation (flexion-distraction injuries with rotation) |
| C2.1.1. Rotational flexion subluxation |
| C2.1.2. Rotational flexion subluxation with unilateral articular process fracture |
| C2.1.3. Unilateral dislocation |
| C2.1.4. Rotational anterior dislocation without/with fracture of articular processes |
| C2.1.5. Rotational flexion subluxation without/with unilateral articular process + type A fracture |
| C2.1.6. Unilateral dislocation + type A fracture |
| C2.1.7. Rotational anterior dislocation without/with fracture of articular processes + type A fracture |
| C2.2. B2 injuries with rotation (flexion distraction injuries with rotation) |
| C2.2.1. Rotational transverse bicolumn fracture |
| C2.2.2. Unilateral flexion spondylolysis with disruption of the disc |
| C2.2.3. Unilateral flexion spondylolysis + type A fracture |
| C2.3. B3 injuries with rotation (hyperextension-shear injuries with rotation) |
| C2.3.1. Rotational hyperextension-subluxation without/with fracture of posterior vertebral elements |
| C2.3.2. Unilateral hyperextension-spondylolysis |
| C2.3.3. Posterior dislocation with rotation |
| C3. Rotational-shear injuries |
| C3.1. Slice fracture |
| C3.2. Oblique fracture |
Table 4 Thoracolumbar injury classification and severity score injury classification system
| Injury category | Point value |
| Injury morphology | |
| Compression | 1 |
| Burst | 2 |
| Translation or rotation | 3 |
| Distraction | 4 |
| PLC Status | |
| Intact | 0 |
| Injury suspected or indeterminate | 2 |
| Injured | 3 |
| Neurologic status | |
| Intact | 0 |
| Nerve root involvement | 2 |
| Spinal cord or conusmedullaris injury | |
| Incomplete | 2 |
| Complete | 3 |
| Cauda equina syndrome | 3 |
Table 5 Surgical vs non-surgical decision system according to thoracolumbar injury classification and severity score classification
| TLICS score | Treatment recommendation |
| 0-3 | Nonsurgical |
| 4 | Nonsurgical or surgical |
| ≥ 5 | Surgical |
Table 6 Surgical approach based on posterior ligamentous complex integrity
| Neurologic status | Surgical approach | |
| Intact PLC | Disrupted PLC | |
| Intact or nerve root injury | Posterior | Posterior |
| Incomplete cord injury | Anterior | Combined |
| Complete cord injury | Anterior or posterior | Combined or posterior |
Table 7 Check-list of findings to be reported on computed tomography[32]
| Injury morphology |
| Primary injury pattern (compression, burst, translation, flexion-distraction) |
| Basic morphologic description of lesion |
| Vertebral height loss (approximate percentage) |
| Retropulsion with central spinal canal narrowing (approximate percentage) |
| Other contiguous or noncontiguous injuries |
| Degree of kyphosis |
| PLC injury predictors |
| Facet joint widening |
| Interspinous distance widening |
| Spinous process avulsion fracture |
| Vertebral body subluxation or dislocation |
Table 8 Checklist of findings to be evaluated on magnetic resonance imaging
| Osseous (similar to injury morphology noted at CT) and soft tissue injuries |
| PLC status (intact, indeterminate, or disrupted) |
| Supraspinous ligament |
| Ligamentumflavum |
| Interspinous ligaments |
| Facet capsule |
| Disks |
| Anterior and posterior longitudinal ligaments |
| Neurologic injuries |
| Spinal cord and conusmedullaris |
| Cauda equina |
| Nerve root injury |
| Epidural hematoma |
- Citation: Gamanagatti S, Rathinam D, Rangarajan K, Kumar A, Farooque K, Sharma V. Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review. World J Radiol 2015; 7(9): 253-265
- URL: https://www.wjgnet.com/1949-8470/full/v7/i9/253.htm
- DOI: https://dx.doi.org/10.4329/wjr.v7.i9.253