335 - Evaluation and Classification of Spinal Instability

Abstract

The determination of spinal stability, defined as the ability of the spine under physiologic loads to resist abnormal displacement, is critical in the management of all trauma patients. The interplay of the vertebrae, the intervertebral disk, and the spinal ligaments plays a key role in maintaining spinal stability. Clinicians must first determine if spinal imaging is necessary based on available information such as advanced age, pain, neurological injury, distracting injury, altered mentation, and mechanism of injury. CT is the preferred imaging modality in all regions of the spine. MRI and dynamic radiography can be used as adjunct studies in certain cases. Once a spinal column injury has been confirmed, classification of the injury is critical to further management. The Subaxial Injury Classification and Severity scale (SLICS) and the Thoracolumbar Injury Classification and Severity scale (TLICS) are the most widely used classification systems currently. These systems take into account bony pathomorphology, integrity of the ligamentous structures and intervertebral disk, and neurological condition. Inadequate or inappropriate treatment of traumatic spinal column injuries may lead to delayed posttraumatic instability.