Orthopedic Essentials - Spinal Trauma and Spine Classification
DENIS THREE COLUMN CONCEPT
Anterior column:
AAL: Anterior longitudinal ligament
AAF: Anterior annulus fibrosus
Middle column:
PLL: Posterior longitudinal ligament
PAF: Posterior annulus fibrosus
Posterior column:
SSL: Supraspinous ligament
ISL: Interspinous ligament
LF: Ligamentum flavum
PC: Facet capsule
DENIS CLASSIFICATION OF SPINAL TRAUMA: Compression Fracture, Burst Fracture, Chance Fracture
MINOR INJURIES
• Transverse process fracture
• Articular process fracture
• Par interarticularis fracture
• Spinous process fracture
Stable fractures: Don't cause spinal deformity or neurologic deficit, still able to weight bear
Unstable fractures: Unable to weight bear, may progress and causing further neurological and structural damage.
Criteria of unstable spine injury:
• On palpation gap between 2 spinous processes increased
• Neurological deficit
• Vertebral compression >1/3
• Vertebral displacement >1/3
• Vertebral canal compromisation > 1/3
• Bilateral facet joints dislocation
• According to Denis 3 columns concept: 2 columns disrupted
TLICS: Thoracolumbar Injury Classification and Severity Score
Morphology
0 No abnormality
1 Compression
2 + Burst fracture
3 Rotation/translation
4 Distraction
Posterior Ligamentous complex (PLC)
0 Intact
2 Suspected / Indeterminate
3 Injured
Neurological status
0 Intact
2 Root injury
2 Complete cord / conus medullaris injury
3 Incomplete cord / conus medullaris injury
3 Cauda equina
Treatment
TLICS <= 3: non-operative
TLICS = 4: consider for operative or non-operative intervention
TLICS >=5: operative
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