Seminars in Spine Surgery
Volume 22, Issue 1 , Pages 2-7 , March 2010

Anatomy, Biomechanics, and Classification of Thoracolumbar Injuries

  • Harvey E. Smith, MD

      Affiliations

    • Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA
    • ,
  • D. Greg Anderson, MD

      Affiliations

    • Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA
    • Corresponding Author InformationAddress reprint requests to D. Greg Anderson, MD, Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107
    • ,
  • Alexander R. Vaccaro, MD, PhD

      Affiliations

    • Department of Orthopaedic and Neurosurgery, Thomas Jefferson University Hospital and the Rothman Institute, Philadelphia, PA
    • ,
  • Todd J. Albert, MD

      Affiliations

    • Department of Orthopaedic and Neurosurgery, Thomas Jefferson University Hospital and the Rothman Institute, Philadelphia, PA
    • ,
  • Alan S. Hilibrand, MD

      Affiliations

    • Department of Orthopaedic and Neurosurgery, Thomas Jefferson University Hospital and the Rothman Institute, Philadelphia, PA
    • ,
  • James S. Harrop, MD

      Affiliations

    • Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
    • ,
  • John K. Ratliff, MD

      Affiliations

    • Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA

References 

  1. Stagnara P, De Mauroy JC, Dran G, et al. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine. 1982;7:335–342
  2. White AA, Panjabi MM. The basic kinematics of the human spine (A review of past and current knowledge). Spine. 1978;3:12–20
  3. Panjabi MM, Brand RA, White AA. Three-dimensional flexibility and stiffness properties of the human thoracic spine. J Biomech. 1976;9:185–192
  4. Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am. 1970;52:1534–1551
  5. Weitzman G. Treatment of stable thoracolumbar spine compression fractures by early ambulation. Clin Orthop Relat Res. 1971;76:116–122
  6. Denis F, Burkus JK. Shear fracture-dislocations of the thoracic and lumbar spine associated with forceful hyperextension (lumberjack paraplegia). Spine. 1992;17:156–161
  7. Burke DC. Hyperextension injuries of the spine. J Bone Joint Surg Br. 1971;53:3–12
  8. In:  Browner BD,  Jupiter JB,  Levine AM, et al. editor. Skeletal Trauma: Basic Science, Management, and Reconstruction. Philadelphia, PA: WB Saunders; 2003;
  9. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817–831
  10. Chance G. Note on a type of flexion fracture of the spine. Br J Radiol. 1948;21:452–453
  11. Nicoll E. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br. 1949;31:376–394
  12. Lee HM, Kim HS, Kim DJ, et al. Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures. Spine. 2000;25:2079–2084
  13. Lee JY, Vaccaro AR, Lim MR, et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci. 2005;10:671–675
  14. Vaccaro AR, Kim DH, Brodke DS, et al. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect. 2004;53:359–373
  15. Vaccaro AR, Lee JY, Schweitzer KM, et al. Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J. 2006;6:524–528
  16. 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. 2005;30:2325–2333
  17. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3:184–201
  18. Gertzbein SD. Spine update (Classification of thoracic and lumbar fractures). Spine. 1994;19:626–628
  19. 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;87:1423–1429
  20. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994;19:1741–1744
  21. 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. 2000;25:1157–1170
  22. Dai LY, Jin WJ. Interobserver and intraobserver reliability in the load sharing classification of the assessment of thoracolumbar burst fractures. Spine. 2005;30:354–358
  23. Aligizakis A, Katonis P, Stergiopoulos K, et al. Functional outcome of burst fractures of the thoracolumbar spine managed non-operatively, with early ambulation, evaluated using the load sharing classification. Acta Orthop Belg. 2002;68:279–287
  24. Wang XY, Dai LY, Xu HZ, et al. The load-sharing classification of thoracolumbar fractures: an in vitro biomechanical validation. Spine. 2007;32:1214–1219
  25. Scholl BM, Theiss SM, Kirkpatrick JS. Short segment fixation of thoracolumbar burst fractures. Orthopedics. 2006;29:703–708
  26. James KS, Wenger KH, Schlegel JD, et al. Biomechanical evaluation of the stability of thoracolumbar burst fractures. Spine. 1994;19:1731–1740
  27. Vaccaro AR, Zeiller SC, Hulbert RJ, et al. The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech. 2005;18:209–215
  28. Vaccaro AR, Baron EM, Sanfilippo J, et al. Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score. Spine. 2006;31:S62–S69discussion S104
  29. Ballock RT, Mackersie R, Abitbol JJ, et al. Can burst fractures be predicted from plain radiographs?. J Bone Joint Surg Br. 1992;74:147–150

PII: S1040-7383(09)00078-1

doi: 10.1053/j.semss.2009.10.001

Seminars in Spine Surgery
Volume 22, Issue 1 , Pages 2-7 , March 2010

Article Tools

* Image Usage & Resolution