A Review of Thoracolumbar Spine Fracture Classifications

Abstract

The management of traumatic thoracolumbar spine fractures has been controversial. Most columnar models explain stability based on the sagital profile of the spine. In Denis' classification, the middle column provides the greatest mechanical stability and bears the greatest axial load of the spine. The load sharing classification scores the extent of damage to the vertebral body, the displacement of fragments at the fracture site, and the amount of corrected kyphosis. Recently, TLICS was devised based upon the currently recognized three most important injury characteristics: (1) radiographic morphology of injury, (2) integrity of the posterior ligamentous complex, and (3) neurological status of the patient. Subsequently, a composite score (TLISS) can be calculated and patients are stratified into surgical and non-surgical treatment. The emphasis placed on the posterior ligamentous complex as a determinant of spinal stability, encourages magnetic resonance imaging to be the investigation of choice for most thoracolumbar spinal injuries.