Abstract
Radiologists frequently interpret cross-sectional imaging of the spine in the setting of trauma. Mechanical stability of the traumatised spine is the single most important factor which guides further management.
 Several classification systems have been developed over the past to assist radiologists to judge the potentially unstable injuries. The radiologists are arguably most familiar with Denis system of classification which is based on injury morphology and mechanism. This system has been criticised for being too simple, not prognostically valuable and lack of consideration of patients' neurological status. AO (Arbeitsgemeinschaft für Osteosynthesefragen) and TLICS (Thoracolumbar Injury Classification and Severity Score ) classification systems are the next major evolutions which highlight the importance of the posterior ligamentous complex (PLC) and neurological status of the patients in predicting the potentially unstable fracture.
 The aim of this pictorial review is to familiarise radiologists with newer classification systems to improve their image interpretation skills and promote efficient communication with spinal surgeons. The pictorial examples are intended to illustrate the various injury types and how to classify them according to the aforementioned classification systems.
Highlights
Spinal trauma occurs in approximately 10% of adult major trauma patients.[1]
Thoracolumbar Injury Classification and Severity Score (TLICS) assigns a numerical score based on the (A) fracture morphology, (B) integrity of the posterior ligamentous complex (PLC) and (C) neurological status of the patient to help guide treatment.[9]
Multiple mechanisms of injury and differing practices in management have led to difficulties in designing single comprehensive universally accepted classification
Summary
Spinal trauma occurs in approximately 10% of adult major trauma patients.[1]. Spinal fractures and dislocations without neurological injury account for the majority of spinal trauma (9.6% of trauma patients) and occur mainly in the thoracolumbar spine.[1,2] Around 50-60% of thoracolumbar fractures involve the T11-L2 levels.[2]. Younger patients below the age of 44 and male patients tend to be at greatest risk of spinal trauma.[1,2]. The initial investigation of spinal trauma usually comprises plain film and CT, with CT routinely used first line in seriously injured patients. It is important for the general radiologist to be familiar with the various patterns of injury and their clinical. Radiological assessment of Sub-axial spinal injury relevance to help guide further management. This pictorial reviews the relevant clinical anatomy and classification systems used in spinal trauma, describes our imaging protocol and provides examples to illustrate the various classification systems.
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