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Spinal Fractures Classification System an Aospine Knowledge Forum Initiative

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Spinal Fractures Classification System an Aospine Knowledge Forum Initiative Spinal Fractures Classification System an AOSpine Knowledge Forum initiative Subaxial Spine Fractures Thoracolumbar Spine Fractures Sacral Spine Fractures AOSpine–the leading global academic community for innovative education and research in spine care, inspiring lifelong learning and improving patients’ lives. Spinal Fractures Classification System 2 Spinal Fractures Classification System an AOSpine Knowledge Forum initiative CONTENT AOSpine Classification and Injury Severity System ................ 04 for Traumatic Fractures of the Subaxial Spine AOSpine Classification and Injury Severity System ................. 37 for Traumatic Fractures of the Thoracolumbar Spine AOSpine Classification and Injury Severity System .................55 for Traumatic Fractures of the Sacral Spine Spinal Fractures Classification System 3 AOSpine Knowledge Forum AOSpine Classification and Injury Severity System for Traumatic Fractures of the Subaxial Spine This is the present form of the classification the AOSpine Knowledge Forum (KF) SCI & Trauma is working on. It is the aim of the KF to develop a system, which can in the future be used as a tool for scientific research and a guide for treatment. This system is being subjected to a rigorous scientific assessment. Project members Aarabi B, Bellabarba C, Chapman J, Dvorak M, Fehlings M, Kandziora F, Kepler C, (in alphabetic order) Oner C, Rajasekaran S, Reinhold M, Schnake K, Vialle L and Vaccaro A. Disclaimer 1. Vaccaro, A. R., J. D. Koerner, K. E. Radcliff, F. C. Oner, M. Reinhold, K. J. Schnake, F. Kandziora, M. G. Fehlings, M. F. Dvorak, B. Aarabi, S. Rajasekaran, G. D. Schroeder, C. K. Kepler and L. R. Vialle (2015). “AOSpine subaxial cervical spine injury classification system.” Eur Spine J. 2. International validation process to be completed in 2015. 3. Submitted to AOSpine International Board for endorsement as the official AOSpine TL Fractures Classification Compression injuries Type Description No bony injury or minor injury such as an isolated lamina fracture Minor, nonstructural fractures AO or spinous process fracture. Compression fracture involving a single endplate without involvement Wedge-compression A1 of the posterior wall of the vertebral body. Coronal split or pincer fracture involving both endplates without Split A2 involvement of the posterior wall of the vertebral body. Burst fracture involving a single endplate with involvement of the Incomplete burst A3 posterior vertebral wall. A4 Complete burst Burst fracture or sagittal split involving both endplates. Subaxial Spine Fractures Classification System 5 Tension band injuries Type Description Posterior tension band injury Physical separation through fractured bony structures only. B1 (bony) Posterior tension band injury Complete disruption of the posterior capsuloligamentous or bony B2 (bony capsuloligamentous, capsuloligamentous structures together with a vertebral body, disk, ligamentous) and/or facet injury. Physical disruption or separation of the anterior structures Anterior tension band injury B3 (bone/disk) with tethering of the posterior elements. Subaxial Spine Fractures Classification System 6 Translation injuries Type Translational injury in any axis-displacement or translation C of one vertebral body relative to another in any direction Bilateral injuries Type BL Bilateral injury Subaxial Spine Fractures Classification System 7 Facet injuries Type Description F1 Nondisplaced facet fracture With fragment <1cm in height, <40% of lateral mass. Facet fracture with potential With fragment >1cm, > than 40% lateral mass, or displaced. F2 for instability F3 Floating lateral mass Pathologic subluxation or F4 perched/ dislocated facet Subaxial Spine Fractures Classification System 8 Neurological status modifier Neurologic status at the moment of admission should be scored according to the following scheme: Type Description NO Neurologically intact N1 Transient neurologic deficit, resolved N2 Radiculopathy N3 Incomplete spinal cord injury N4 Complete spinal cord injury NX Cannot be examined Subaxial Spine Fractures Classification System 9 Case-specific modifiers There are four modifiers, which can be used in addition to ad 1 and 2: Type Description M1 Posterior capsuloligamentous complex injury without complete disruption M2 Critical disk herniation M3 Stiffening/metabolic bone disease (ie.: DISH, AS, OPLL, OLF) M4 Vertebral artery abnormality Subaxial Spine Fractures Classification System 10 Classification nomenclature Injuries are first classified by their level and primary injury type, either C, B, or A. If there are multiple levels, the most severe level is classified first. The secondary injuries are parenthesized. For example, a C6-C7 translational injury (C) with a C7 compression fracture (A1) would be classified as: C6-C7:C (C7:A1) And a C5-C6 flexion distraction injury (B2) with a C6 compression fracture (A1) would be classified as: C5-C6:B2 (C6:A1) Subaxial Spine Fractures Classification System 11 Classification–Facet Injuries Included in parenthesis are the remaining subgroups in the order of: facet injuries, neurological status, and any modifiers. For bilateral facet injuries, the “BL” modifier is added after the facet injury if the injuries are the same. For example, a C6-C7 flexion distraction injury (B2) with bilateral facet dislocation (F4) would be classified as: C6-C7:B2 (F4 BL) When there are different facet injuries to the same level, the right side is listed first, then the left. For example, a C6-C7 flexion distraction injury (B2) with right sided facet dislocation (F4) and a left sided displaced facet fracture (F2) would be classified as: C6-C7:B2 (F4, F2) If there are multiple injuries to the same facet (For example: small fracture (F1) and dislocation (F4), only the highest level facet injury is classified (F4). If only facet injuries are identified (No A, B, or C injury), they are listed first after the level of injury. Subaxial Spine Fractures Classification System 12 Type A: Compression injuries A0. Minor, nonstructural fractures No bony injury or minor injury such as an isolated lamina fracture or spinous process fracture. Subaxial Spine Fractures Classification System 13 Type A: Compression injuries A1. Wedge-compression Compression fracture involving a single endplate without involvement of the posterior wall of the vertebral body. Subaxial Spine Fractures Classification System 14 Type A: Compression injuries A1. Wedge-compression Compression fracture involving a single endplate without involvement of the posterior wall of the vertebral body. Subaxial Spine Fractures Classification System 15 Type A: Compression injuries A2. Split Coronal split or pincer fracture involving both endplates without involvement of the posterior wall of the vertebral body. Subaxial Spine Fractures Classification System 16 Type A: Compression injuries A3. Incomplete burst Burst fracture involving a single endplate with involvement of the posterior vertebral wall. Subaxial Spine Fractures Classification System 17 Type A: Compression injuries A3. Incomplete burst Burst fracture involving a single endplate with involvement of the posterior vertebral wall. Subaxial Spine Fractures Classification System 18 Type A: Compression injuries A4. Complete burst Burst fracture or sagittal split involving both endplates. Subaxial Spine Fractures Classification System 19 Type A: Compression injuries A4. Complete burst Burst fracture or sagittal split involving both endplates. Subaxial Spine Fractures Classification System 20 Type A: Compression injuries A4. Complete burst Burst fracture or sagittal split involving both endplates. Subaxial Spine Fractures Classification System 21 Type B: Tension band injuries B1. Posterior tension band injury (bony) Physical separation through fractured bony structures only. Subaxial Spine Fractures Classification System 22 Type B: Tension band injuries B2. Posterior tension band injury (bony capsuloligamentous, ligamentous) Complete disruption of the posterior capsuloligamentous or bony capsuloligamentous structures together with a vertebral body, disk, and/or facet injury. Subaxial Spine Fractures Classification System 23 Type B: Tension band injuries B3. Anterior tension band injury Physical disruption or separation of the anterior structures (bone/disk) with tethering of the posterior elements. Subaxial Spine Fractures Classification System 24 Type C: Translation injuries C. Translational injury in any axis-displacement or translation of one vertebral body relative to another in any direction Subaxial Spine Fractures Classification System 25 Bilateral injuries BL. Bilateral injury Subaxial Spine Fractures Classification System 26 Facet injuries F1. Nondisplaced facet fracture With fragment <1cm in height, <40% of lateral mass. Subaxial Spine Fractures Classification System 27 Facet injuries F2. Facet fracture with potential for instability With fragment >1cm, > than 40% lateral mass, or displaced. Subaxial Spine Fractures Classification System 28 Facet injuries F3. Floating lateral mass Subaxial Spine Fractures Classification System 29 Facet injuries F4. Pathologic subluxation or perched/dislocated facet Subaxial Spine Fractures Classification System 30 Facet injuries F4. Pathologic subluxation or perched/dislocated facet Subaxial Spine Fractures Classification System 31 Facet injuries F4. Pathologic subluxation or perched/dislocated facet Subaxial Spine Fractures Classification System 32 Case Example 1. 25 year old male involved in high speed MVA, complete SCI C7-T1: C (T1:A1; F4 BL;
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