Thoracolumbar Fracture Classification System A New Approach Spine Trauma Study Group Alexander R Vaccaro M.D. Professor Thomas Jefferson University Department.

Slides:

Advertisements

Similar presentations

Thoraco-Lumbar Radiography

Advertisements

Oliver I. Schmidt, Ralf H. Gahr

Mike Rissing Associate Student of Clinical Medicine

Acute Cervical Injuries In Football

Classification of Thoracolumbar spine injuries

Classification of Thoracolumbar Spine Injuries

Consultant Orthopedic & Spinal Surgeon

Thoracolumbar Fractures Patient Evaluation and Management.

Cervical Spine Trauma Aaron B. Welk, DC Resident, Department of Radiology Logan College of Chiropractic.

Elda Baptistelli de Carvalho, MD, PGY-3 University of Toronto

The cervical spine. Normal anatomy, variants and pathology.

Spine and spinal cord injuries

Emergency Spinal Radiological Assessment

Mike Gibson Glasgow Post Orthopaedic Training Program February 2011 Thoraco-Lumbar Fractures.

Evaluation and Treatment of the Cervical Spine

Spinal Trauma. Anatomy and Physiology  Vertebral Column  Spinal Cord.

Thoracic and Lumbar Spine Trauma

Common adult fractures Axial skeleton (Pelvis) Waleed M. Awwad, MD. FRCSC Assistant professor and Consultant Orthopedic Surgery department.

C SPINE Y A Mamoojee.

SUBAXIAL CERVICAL SPINE TRAUMA- DIAGNOSIS AND MANAGEMENT

Assessment of Spinal Injury

Lower Lumbar Fractures Wayne Cheng, MD. Duke University Medical Center.

Steven Mardjetko M.D. A. Professor Rush University Dept. of Orthopedic Surgery Illiniois Bone and Joint Institute PedSpine.com.

9 Spine and thorax. CLASSIFICATION Injuries of the spine and thorax may be classified as follows: A-Major fractures and displacements of the thoracic.

Patrick Do, MD Jeffrey Dorr, MD Priya Krishnarao, MD Mahesh Patel, MD

Radio-Ulnar Fractures

Lumbar spine fracture and dislocation

Diagnosis and Management of Thoracolumbar Spine Fractures by Alexander R. Vaccaro, David H. Kim, Darrel S. Brodke, Mitchel Harris, Jens Chapman, Thomas.

Waleed Awwad. MD, FRCSC Assistant professor Consultant spine and scoliosis Waleed Awwad. MD, FRCSC Assistant professor Consultant spine and scoliosis.

Traumatic conditions of Dorso-Lumbar spine.

بسم اللـه الرحمن الرحيم

Vertebral Fracture Classification By Advanced Imaging Jalal Jalal Shokouhi-M.D. General secretary of ISR (Iranian society of radiology)

Update in Subaxial Cervical Trauma: What the Clinician Needs to Know Roy Riascos, MD Eliana Bonfante, MD Claudia Cotes, MD Clark Sitton, MD Maria Gule-Monroe,

Thoraco-lumbar fractures Common injuries. 50% caused by MVA; rest by falls and sporting injuries. Commonly associated injuries; injuries at another level(10%-15%),

Jim A. Youssef, MD; Revised January 2006 and May 2011

epidemiology Occurrence per 100,000 2 deaths per 100,000 population due to spinal injury male/female ratio 3/1.

Evaluation of the Traumatic Spine

SPINE TRAUMATOLOGY M. Krbec, M. Repko, M. Rouchal,

SPINE ORTHOSES Michael Zlowodzki MD University of Minnesota Department of Orthopaedic Surgery.

Spinal cord compression in spine tumours and injuries Chaloupka, R., Grosman, R., Repko, M., Tichý, V. Ortopedická klinika, FN Brno, Jihlavská 20, 625.

Daniel S. Chow, MD Jason Talbott, MD

THORACO-LUMBAR FRACTURES OF SPINE Presenter : Dr. Sunil santhosh.g Ms Ortho Narayana medical college.

LECTURE: Dr.Khudur Shukur (F.I.B.M.S, Neurosurgery)

Spinal injuries Principles and treatment

Mark L Prasarn MD University of Texas Dept of Orthopaedic Surgery

Instability criteria for cervical surgery. The lower cervical spine

Introduction to Orthopaedics

Thoracolumbar Fractures

Thoracolumbar Fractures

Cervical Spine Trauma Odontoid fractures Anatomic pathology

Spine fractures: Anatomy, pathology & treatment options

Pelvic injuries.

Follow up CT scan on 20 year old male with back pain

Naftaly Attias, MD Orthopedic Department St Josephs HMC –Phoenix, AZ

Patrick Sanchez, Duy Bui ASNR 2016 Annual Meeting

Cervical Spine Assessment

Thoraco- Lumbar Spine Fractures and Dislocations

Thoracolumbal Injury Team VI Chief : MH Members: ET/MB/RF Moderator : SG Supervisor : DR.dr.Karya Triko Biakto, Sp.OT(K) Spine Thursday, December 15th.

بسم الله الرحمن الرحیم.

Department of Rehabilitation Nakornping hospital

Trauma to the Spine and Spinal Cord.

WARRAICH ROLL#17-C Elbow Dislocation Basics

Spinal fractures.

Spinal Cord (CNS BLOCK, RADIOLOGY).

Spinal fractures By: Asal Alqum.

Garrido E†, Bermejo F†, Tucker SK†‡, Noordeen HNN†‡, Morley TR‡

Presentation transcript:

Thoracolumbar Fracture Classification System A New Approach Spine Trauma Study Group Alexander R Vaccaro M.D. Professor Thomas Jefferson University Department of Orthopaedics and the Rothman Institute

Fracture Description (Morphometric) Spine Trauma Study Group Thoracolumbar Classification System Three Part Description Fracture Description (Morphometric) Neurologic Status Integrity of PLC

Fracture Description (Morphology) Compression-axial, flexion,distraction,translation/rotation Distraction- extension,flexion,translation/rotation, compression Translation/Rotation-flexion, distraction

Neurologic Status Intact Nerve Root Injury Cauda Equina Injury Cord Injury-Incomplete, Complete

Posterior Ligamentous Complex Intact Disrupted In Tension

Treatment Determined by: Mechanism Neurology Ligament/ bone Integrity

Mechanism-Point System Two Component Mechanistic Description Compression 1 Translation / Rotation 3 Distraction 3

Neurology-Point System Intact Nerve root Cauda equina 1 3 Cord Incomplete Complete 3 2

Stability-Soft Tissue Point System Ligaments Intact 0 PLC Injured 3 Evaluated by MRI

Stability Spinal Column Point System Anterior Posterior 1 1 Middle 1

Next Step - Direct TX Assign Points Conservative Surgery

Translation/Rotation - 3 Point System Mechanism Ligament Translation/Rotation - 3 PLC - 3 Distraction - 3 Compression - 1 Neurology Spinal Column Cauda equina - 3 Anterior - 1 Incomplete - 3 Middle - 1 Complete - 2 Posterior - 1 Root - 1

Treatment Fractures with 4 points or less = non operative Fractures with 5 points=Nonop vs Op Fractures with 6 points or more = surgery

Examples Anterior Compression Fx Compression ( mechanism) - 1 Intact (neurology) - 0 PLC (ligament) no injury - 0 Anterior Column - 1 Total 2 points- Non Op

Example Stable Burst Fracture Compression (mechanism) - 1 Intact ( neurology) - 0 PLC (ligament) no injury (0) Ant/Middle column 1+1 Total 3 points-Non Op

Example Unstable Burst-Complete Neuro Injury Compression (mechanism) -1 Complete (neurology) - 2 PLC (ligament) injury - 3 Ant/Middle column -1+1 Total 8 points-Surgery

Example Stable Burst-Complete injury Compression-1 Complete neurology-2 PLC Intact-0 Anterior, Middle Column disruption- 1+1 Points 5-Non Op vs Op

Example Fx Dislocation Translation/rotation - distraction (mechanism) - 3 + 3 Complete (neurology) - 2 PLC (ligament) injury - 3 Anterior column - 1 Total 12 points-Surgery

Surgically Indicated Patients Approach Selection Neurology Ligament Status Modifiers

Approach Selection Posterior alone vs. Neurologically Intact Ligament Injury present Posterior alone vs. Anterior alone vs. Combined

Approach Selection Combined vs Neurologically Incomplete Ligament Injury No Yes Combined vs Anterior Anterior Modifier – Osteoporosis Combined

Approach Selection Neurologically Complete Injury Posterior

Thoracolumbar Fracture Classification System Point system to determine nonoperative vs operative treatment Neurology, ligamentous status helps determine surgical approach Validation necessary

Thank You