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The complex shape of the vertebra, along with the interaction of Central Nervous system and interactions with relatively specialized structures like the intervertebral disks the associated vertebral ligaments has made the description and classification of spinal fractures an ongoing pursuit for the medical community. The current system had its roots in 1963 after Holdsworth proposed classifying spinal fractures by the MOI of compression, flexion, extension, and flexion-rotation. He divided the injuries involvement of the anterior weight bearing column and the posterior “tension bearing” column of facet joints and ligament complex <sup>2</sup>. <br> | The complex shape of the vertebra, along with the interaction of Central Nervous system and interactions with relatively specialized structures like the intervertebral disks the associated vertebral ligaments has made the description and classification of spinal fractures an ongoing pursuit for the medical community. The current system had its roots in 1963 after Holdsworth proposed classifying spinal fractures by the MOI of compression, flexion, extension, and flexion-rotation. He divided the injuries involvement of the anterior weight bearing column and the posterior “tension bearing” column of facet joints and ligament complex <sup>2</sup>. <br> | ||
In 1983 the Denis system revised this to add in a center column comprised of the posterior vertebral body, posterior vertebral disk and Posterior Longitudinal ligament <sup>2</sup>[[Image:Vertebral columns.jpg|Image:Vertebral_columns.jpg]] | In 1983 the Denis system revised this to add in a center column comprised of the posterior vertebral body, posterior vertebral disk and Posterior Longitudinal ligament <sup>2</sup>.[[Image:Vertebral columns.jpg|Image:Vertebral_columns.jpg]] | ||
In his paper it was believed that trauma focused into the middle column was sufficient to cause instability in the spine. The instability was further categorized into three types: first degree instability, considered mechanical, second degree instability was considered neurological or combined mechanical/neurological that was considered third degree instability. The Denis system is still currently the favored method. The main frustration from the Denis method is that the inclusion of the middle column introduced a “virtual landmark” that isn’t really suitable for determining an injury type. A recently developed a system by Aebi incorporates the two column method, combined with the method of injury, and the instability which may result in neurological compromise. This method can result in 27 subgroups of spinal fractures <sup>4</sup>! Obviously the classification of fractures is complicated and ongoing. <br> | |||
The American Academy of Orthopedic Surgeons website<sup>5</sup> lists fractures based on the pattern of injury and in a simpler format: | The American Academy of Orthopedic Surgeons website<sup>5</sup> lists fractures based on the pattern of injury and in a simpler format: | ||
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The extension pattern, which contains an extension/distraction (often called a chance fracture). | The extension pattern, which contains an extension/distraction (often called a chance fracture). | ||
The rotation pattern contains transverse process and fracture-dislocation<sup>5</sup> | The rotation pattern contains transverse process and fracture-dislocation<sup>5</sup>. | ||
<br> | <br> | ||
Revision as of 05:26, 2 May 2011
Original Editors
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Search Strategy[edit source]
Database Search: CINHAL, Cochrane Library, JOSPT, PEDro, PubMed
Keywords: lumbar, fracture, management, therapy, burst, osteoporosis, nonoperative, treatment, thoracolumbar
Search Timeline: April 13, 2011 - May 1, 2011
Definition/Description[edit source]
The complex shape of the vertebra, along with the interaction of Central Nervous system and interactions with relatively specialized structures like the intervertebral disks the associated vertebral ligaments has made the description and classification of spinal fractures an ongoing pursuit for the medical community. The current system had its roots in 1963 after Holdsworth proposed classifying spinal fractures by the MOI of compression, flexion, extension, and flexion-rotation. He divided the injuries involvement of the anterior weight bearing column and the posterior “tension bearing” column of facet joints and ligament complex 2.
In 1983 the Denis system revised this to add in a center column comprised of the posterior vertebral body, posterior vertebral disk and Posterior Longitudinal ligament 2.
In his paper it was believed that trauma focused into the middle column was sufficient to cause instability in the spine. The instability was further categorized into three types: first degree instability, considered mechanical, second degree instability was considered neurological or combined mechanical/neurological that was considered third degree instability. The Denis system is still currently the favored method. The main frustration from the Denis method is that the inclusion of the middle column introduced a “virtual landmark” that isn’t really suitable for determining an injury type. A recently developed a system by Aebi incorporates the two column method, combined with the method of injury, and the instability which may result in neurological compromise. This method can result in 27 subgroups of spinal fractures 4! Obviously the classification of fractures is complicated and ongoing.
The American Academy of Orthopedic Surgeons website5 lists fractures based on the pattern of injury and in a simpler format:
The flexion pattern contains compression fractures, and axial burst fractures5.
The extension pattern, which contains an extension/distraction (often called a chance fracture).
The rotation pattern contains transverse process and fracture-dislocation5.
While the listed examples above all imply trauma for a spinal fracture, osteoporosis and conditions such as osteogenesis imperfect are commonly implicated in vertebral fractures as well.
Epidemiology /Etiology[edit source]
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