Thoracic and Lumbar Spine
Fractures and Dislocations:
Assessment and Classification
Jim A. Youssef, M.D.
Original Authors: Christopher Bono, MD and Mitch Harris, MD; March 2004
Jim A. Youssef, MD; Revised January 2006 and May 2011
Anatomy of Thoracic Spine
• Kyphosis is natural
alignment
• Narrow spinal canal
• Facet orientation
• Rib factor on stability
• Conus at T12-L1
Anatomy of Lumbar Spine
• Lordosis is natural
alignment
• Larger vertebral bodies
• Facet orientation
• Cauda equina
Thoracolumbar Junction
Transition Zone
Kyphosis
Lordosis
Mechanical Difference:
Lumbar spine less stiff in
flexion
Transition Zone:
Predisposed to Failure
Little opportunity for
force dispersion
Central loading
of T-L junction
Not anatomically
disposed to transfer force
Patient Evaluation
• Pre-hospital care
• EMT personnel
– Initial assessment
– Transport and immobilization
Patient Evaluation
•
•
•
•
ABC’s of Trauma
History
Physical Examination
Neurological Classification
Clinical Assessment
• Inspection
• Palpation
• Neurological Evaluation
– ASIA Impairment Scale
• Sensory Evaluation
• Motor Evaluation
• Reflex Evaluation
– Bulbocavernosus, Babinski
Clinical Assessment
• Associated Injuries
– Meyer, 1984 – 28% have other major organ
system injuries
– Noncontiguous spine fractures 3-56%
– Always monitor Hematocrit
– GU: Foley recommended, check post-void
residuals, if abnormal get cystometrogram
– GI: prepare for ileus.
Radiographic Evaluation
• Trauma series includes: lateral cervical,
chest, lateral thoracic, A/P and lateral
lumbar and A/P pelvis
• Obtunded patients require further skeletal
survey
– Mackersie et al J Trauma 1988
Additional Imaging
• CT scan – bony injuries
• MRI – images spinal cord, intervertebral
discs, ligamentous structures
CT Scan
• L3 unstable
burst fracture
MRI Scan
• Thoracic fracture
subluxation with
increased signal in
conus medullaris
Thoracolumbar Fractures
Controversies
CLASSIFICATION!!!!!
Indications for surgery
Optimal time for surgery
Best approach for surgery
Classifications Necessary for……
•
•
•
•
Uniform method of description
Directing treatment ***
Facilitating outcome analysis
Should be:
Comprehensive
Reproducible
Usable
Accurate
Böhler 1930
• Importance of injury mechanism
• Determines proper reduction maneuver
• Evaluated fractures using:
• Plain roentgenograms, anatomic dissection of fatalities
• 6 types of spinal fractures included in system
•
•
•
•
•
•
Compression
Flexion
Extension
Lateral flexion
Shear
Torsional
Böhler, Verlag von Wilhem Maudrich 1930
Böhler, Fractures and Dislocation of the Spine, 1956
Morphologic Classification
Watson-Jones 38
• Descriptive terms based on 252 films
– 7 types
Examples:
– Wedge fracture (compression fx)
– Comminuted fracture (burst fx)
– Fracture dislocation
CT evolved MRI evolved
1930
‘40
Morphologic
Classification
‘50
‘60
‘70
‘80
‘90
*
2000
‘10
Morphologic Classification
Stable vs. Unstable
Nicoll 49
• Based on review of 152 coal miners
• Recognized importance of posterior ligaments
• 4 fracture types:
– Stable = post ligaments intact
– Unstable = post elements disrupted
CT evolved MRI evolved
1930
‘40
Morphologic
Classification
‘50
Post elements
important
‘60
‘70
‘80
‘90
*
2000
‘10
Anatomic
Classification
2 or 3
Columns
Denis ‘83
McAfee ‘83
Ferguson &
Allen’84
Holdsworth’62
Kelley &
Whitesides ’68
Anatomic Classification
2 Column Theory
Holdsworth 62
Posterior Anterior
Six types- Nicols +2
– Reviewed 1,000 patients
–1 Anterior- vertebral body, ALL, PLL
• Supports compressive loads
–2 Posterior- facets, arch,
Inter-spinous ligamentous complex
• Resists tensile stresses
• Stressed importance of posterior elements
– If destabilized, must consider surgery
2
1
Anatomic Classification
3 Column Theory
Denis 83
Posterior
Middle Anterior
• Based on radiographic review of 412 cases
• 5 types, 20 subtypes
–1 Anterior- ALL , anterior 2/3 body
–2 Middle - post 1/3 body, PLL
–3 Posterior- all structures posterior to PLL
• Same as Holdsworth
• Posterior injury-not sufficient to cause instability
3
2
1
McAfee Classification
• Six types
• CT based-100 patients
• Middle column most important
Type
Wedge Compression
Stable Burst
Unstable Burst
Flexion-Distraction
Chance
Translational
Anterior
Compression
Compression
Compression
Compression
Tension
Shear
Middle
None
Compression
Compression
Tension
Tension
Shear
COLUMNS
Posterior
None
None
Comp, Lat Flex, Rot
Tension
Tension
Shear
Mechanism
Forward Flexion
Axial Compression
Comp,Lat Flex, Rot
Anterior Fulcrum
Anterior Fulcrum
Shear
Load Sharing Classification
McCormack, Spine 1994
• Review of injuries fixed posteriorly
(McCormack 94)
– Which failed?
– Could they be prevented?
– Suggests when to go anteriorly
CT evolved MRI evolved
1930
‘40
Morphologic
Classification
‘50
Post elements
important
‘60
2 column
‘70
‘80
3 column,
McAfee
Mechanistic classifications
‘90
Load
Sharing
*
2000
‘10
Load Sharing Classification
(McCormack 94)
• Devised method of predicting posterior failure
– 1-3 points assigned to the variables below
– Sum the points for a 3-9 scale
• <6 points posterior only
• >6 points anterior
<30%
30-60%
0-1mm
1-2mm
>2mm
<3°
4-9°
>10°
>60%
Comminution
Fragment Displacement
Kyphosis correction
Mechanistic Classification
AO
• Review of 1445 cases (Magerl, Gertzbein et al. European
Spine Journal 1994)
• Based on direction of injury force
• 3 types,53 injury patterns
– Type A - Compression
– Type B - Distraction
– Type C - Rotational
Increasing severity
CT evolved MRI evolved
1930
‘40
Morphologic
Classification
‘50
Post elements
important
‘60
2 column
‘70
‘80
3 column,
McAfee
Mechanistic classifications
‘90
Load
Sharing
*
2000
AO
‘10
AO Mechanistic Classification
Complex subdivisions to include most fractures
Types
Groups
A1 impaction
A compression A2 split
A3 burst
B1 post ligamentous
B distraction
B2 post osseous
B3 anterior
C1 A with rotation
B rotation
C2 B with rotation
C3 shear
Subgroups Specificastions
A1.1
A1.3
A1.3
A2.1
A2.2
A2.3
A3.1
A3.2
A3.3
B1.1
B1.2
B2.1
B2.2
B2.3
B3.1
B3.2
B3.3
C1.1
C1.2
C2.1
C2.2
C2.3
C3.1
C3.2
A1.2.1, A1.2.2, A1.2.3
A3.1.1, A3.1.2, A3.1.3
A3.2.1, A3.2.2, A3.2.3
A3.3.1, A3.3.2, A3.3.3
B1.1.1, B1.1.2, B1.1.3
B1.2.1, B1.2.2, B1.2.3
B2.2.1, B2.2.2
B2.3.1, B2.3.2
B3.1.1, B3.1.2
C1.2.1, C1.2.2, C1.2.3, C1.2.4
C2.1.1, C2.1.2, C2.1.3, C2.1.4
C2.2.1, C2.2.2, C2.2.3
C2.3.1, C2.3.2, C2.3.3
Classification of thoracic and lumbar spine
fractures: problems of reproducibility
A study of 53 patients using CT and MRI
Oner, European Spine Journal 2002
• 53 Patients
AO & Denis Classifications
5 observers
Cohen Test
0
= No Agreement
1.0 = Perfect Agreement
Results
• AO Interobserver
– CT
– MRI
– CT/MRI
0.31
0.28
0.47
• Denis Interobserver
– CT
– MRI
0.60
0.52
Vaccaro, A.R. et al, Spine 2005
Spine Trauma Study Group
Thoracolumbar Injury
Classification and Severity
Scale (TLICS)
Three Part Description
Injury Morphology
Integrity of PLC
Neurologic Status
Injury Morphology
•Compression: prefix-axial, lateral, flexion,
postfix-burst
•Distraction: prefix-extension, flexion
postfix-compression, burst
•Translation/Rotation: prefix-flexion
postfix-compression, burst
Neurologic Status
•Intact
•Nerve Root Injury
•Cauda Equina Injury
•Cord Injury-Incomplete, Complete
Posterior Ligamentous Complex
• Not disrupted in tension
• Disrupted in tension
Treatment
Spine Trauma Severity Score
Determined by:
• Injury Morphology
• Neurology
• Ligamentous Integrity
Vaccaro, A.R. et al.,
J. Spinal Disorders & Techniques 2005
Point System
Injury Morphology
Select one
Translation /
Compression fx
Axial, Flexion 1
Burst - add 1
Rotation
3
Distraction injury
4
Neurology-Point System
Intact
0
Nerve root
Cauda equina
3
2
Cord
And conus medullaris
Incomplete
3
Complete
2
Posterior Soft Tissue Point System
Intact 0
PLC
(displaced in tension)
Suspected/
Indeterminant
2
Injured 3
Evaluated by MRI, CT,
Plain X-rays, Exam
MODIFIERS
•
•
•
•
AS/ DISH/Metabolic bone disease
Nonbraceable
Sternal fracture
Multiple rib fractures at same or adjacent levels as
fracture
• Multiple trauma
• Coronal plane deformity
• Burns at site of anticipated incision
Next Step - Direct TX
Assign Points
Conservative
Surgery
Treatment
• Injuries with 3 points or less = non
•
•
operative
Injuries with 4 points=Nonop vs Op
Injuries with 5 points or more =
surgery
Examples
Flexion Compression Fx
•Flexion compression (morphology) - 1
•Intact (neurology) - 0
•PLC (ligament) no injury - 0
Total 1 points- Non Op
Compression
Burst Fracture
•Flexion compression burst - 2
•Intact ( neurology) - 0
•PLC (ligament) no injury (0)
Total 2 points-Non Op
Compression
Burst-Complete Neuro Injury
•Axial compression burst with distraction
posterior ligamentous complex -4
•Complete (neurology) - 2
•PLC (ligament) injury - 3
Total 9 points-Surgery
Compression
Burst-Complete injury
• Axial compression burst-2
• Complete (neurology)-2
• PLC (ligament) Intact-0
Points 4-Non Op vs Op
Translational/Rotation Injury
•Distraction, Translation/rotational,
compression injury - 4
•Complete (neurology) – 2
•PLC injury - 3
Total 9 pointsSurgery
Journal of Spinal Disorders & Techniques, 2006
• Surgical Decision making based off tenets of
classification system
– Injury morphology
– Neurological status
– PLC integrity/injury stability
Spine, 2006
• Reliability/treatment validity at single
institution
– Treatment validity exceptional- 96.4%
– Moderate agreement for PLC (66%) and
mechanism (60%)
Conflict: Mechanism vs Morphology
The Journal of Spinal Disorders
and Techniques
Identifying objective findings on
imaging studies and clinical
examination instead of guessing
injury mechanisms provides more
valid understanding of injury
classification
J. Neurosurgery Spine, 2006
• Problems
– Inter-rater agreement on sub-scores was:
• Lowest for mechanisms followed by PLC
• Highest for neurological status
• Substantial for the management recommendation
The Spine Journal, 2006
Status PLC
Most reliable indicators:
• Vertebral body translation on plain
radiographs
• Disrupted PLC components on T1 sagittal
MRI
• Focal kyphosis in absence of vertebral body
injury
Assessment of Injury to the PLC in the
Setting of on Normal Plain Radiographs
Lee, J., Vaccaro, A.R. et al. J Orthopaedic Trauma 2006
Validation Study J. Orthopaedic Research
Submitted 2006
STATUS PLC
- Disrupted PLC components i.e. ISL, SSL, LF;
black stripe on T1 sagittal MRI , most important
factor
- Diastasis of the facet joints on CT
- Fat suppressed T2 sagittal MRI
Lim, Coluna/Columna Journal, 2006
• IMPACT OF EXPERIENCE
(attending surgeons, fellows,
residents, and non-surgeon health
care professionals).
• Most reliable among spine fellows,
followed by attending spine
surgeons.
Spine, 2007
Dramatic Reliability Increase in Latest Evaluation:
Inter-rater Reliability as Assessed by Cohen's Kappa
TJU TLISS June
STSG TLISS July
TJU TLISS Dec
0.50
kappa
• IMPACT OF TRAINING
• Management component:
reliability rose from κ = 0.46
(r=0.47) on first assessment to κ
= 0.72 (r=0.91) on the 2nd
assessment.
0.75
0.25
0.00
Mech
PLC
Total
Management
Rothman/TJU Reliability Study, Fall 2005
J Spinal Disorders, 2006
• DIFFERENCES BETWEEN SPECIALTIES
– Inter-rater reliability: “injury mechanism” higher in
neurosurgeons
– Assessment of PLC, neurological status- higher in
orthopaedic surgeons
– Reliability total score/management recommendations similar
– Overall, differences subtle
World J Emerg Surg, 2007
• DIFFERENCES IN
NATIONALITIES
• Inter-rater reliability for mechanism higher
among non-US surgeons
• Reliability for PLC, neurological status,
management higher among US surgeons
Management of Thoracic and
Lumbar Injuries
CONTROVERSIAL!!!!
Non-Operative Treatment of
Thoracic Spine Injuries
Brace or Cast Treatment
– Compression Fractures
– Stable Burst Fractures
– Pure Bony Flexion-Distraction Injury
Folman and Gepstein, J Orthop Trauma, 2003

85 pts reviewed to determine late outcome of nonop management




Pain intensity correlated with angle of kyphosis


Chronic pain predominant in 69.4%
25% of subjects had changed jobs (most full to part)
48% of subjects filed lawsuits concerning injury
But not w/magnitude of anterior column deformity
Bed rest alone adequately manages traumatic,
uncomplicated thoracolumbar wedge fractures
Agus, Eur J Spine, 2005

Evaluated 29 pts with 2- or 3-column-injured thoracolumbar burst
fractures
No correlation was found between radiological
&functional parameters
 Vertebral column deformity that occurred after the
injury was stable in 2-column; progressive in 3column
 Significant remodeling of canal encroachment
(CE) proportional to initial amount of CE but not
related to age & radiology

Koller, Eur Spine J, 2008

Evaluated 21 pts; 9.5 yr f/u
62% showing good or excellent outcome
 38% showing moderate or poor outcome
 Significant effects on clinical outcome:
 Load-sharing classification, posttraumatic
kyphosis & overall  lumbopelvic lordosis
 Surgical reconstruction appropriate treatment in
more severe fractures

Surgical Management of
Thoracolumbar Injuries
•
•
•
•
•
Unstable burst fractures
Purely ligamentous
Facet dislocations
Translational injuries
Neurologic deficit
Dai, J Trauma, 2004


147 pts w/acute thoracolumbar fractures: 1988 to 1997
Min. 3yr f/u; 4 pts died during hospital stay
Delayed diagnosis in 28 pts (19%)
 Differences b/w surgical & non:
  in pulmonary complications & length of
hospital stay in non-op pts.
 Surgical pts had highly significantly less pain
 Radiographic studies should be performed
 Choice of treatment in pts with multiple injuries is
not different from that in pts with no asscd
injuries

Thomas, J Neurosurg Spine, 2006

Evaluated scientific literature on operative & non-op treatments
Lack of evidence demonstrating superiority of one
approach over the other
 No evidence linking posttraumatic kyphosis to
clinical outcomes
 Strong need for improved clinical research
methodology to be applied to this patient
population

Dai, Spine, 2008
Reviewed 37 pts
 Accuracy of plain radiographs improved
w/experience of observers
 Impact of disagreement on treatment plan was
significant
 Plain radiography alone is not adequate

Acosta, J Neurosurg Spine, 2008


Biomechanical comparison of 3 fixation techniques for unstable
thoracolumbar fractures.
Induced at L1:
1) Short-segment anterolateral fixation
2) Circumferential fixation
3) Extended anterolateral fixation
Extended anterolateral fixation is biomechanically
comparable to circumferential fusion
 Extension of anterior instrumentation & fusion 1level above and below the unstable segment can
result in near equivalent stability to a 2-stage
circumferential procedure

Disch, Spine, 2008
Angular stable plate system showed higher
primary and secondary stability
 In specimens with lower BMD, the use of angular
stable systems substantially increased stability

Whang, J Am Acad Orthop Surg, 2008

Difficult to establish the ideal surgical approach



Anterior decompression assocd w/ recovery of motor
strength & bowel/bladder fxn;  pain & improve
neuro status
Stand-alone anterior constructs:  complications & 
likely to have revision
More definite evidence required to determine best
surgical strategy
Conclusions on Treatment
• Surgically treating incomplete neuro
deficits potentiates improvement and
rehabilitation
• Complete neuro deficits may benefit from
operative treatment to allow mobilization
• Little chance of developing neuro deficits
with nonoperative treatment
Surgery:
Anterior versus Posterior
• Anterior
– More predictable
decompression
– Saves levels
– Questionable improved
recovery of neuro
function
– Gertzbein,1992 – may be
indicated in bladder
dysfunction
– McAfee, 1985 – neuro
recovery in 70 patients
• Posterior
– Less morbidity
– Failures with short –
segment constructs
– Usually requires more
levels
– Less blood loss
– Transpedicular anterior
column bone grafting may
protect posterior construct
Thank You
Bibliography
Meyer PR Jr, Sullivan DE. Injuries to the spine. Emerg Med Clin North Am. 1984 May;2(2):313-29.
Mackersie RC, Shackford SR, Garfin SR, Hoyt DB. Major skeletal injuries in the obtunded blunt trauma patient: a case for routine radiologic survey J Trauma. 1988 Oct;28(10):1450-4.
Bohler L. Die techniek de knochenbruchbehandlung imgrieden und im kriege. Verlag von Wilhelm Maudrich 1930 (in German)
Bohler L. Mechanisms of fracture and dislocation of the spine in the treatment of fractures. 5 th English ed. Fractures and dislocation of the spine. Bohler L, editor. Vol. 1. Grune and Straton, Inc: New York; 1956. p. 300-29.
Watson-Jones R. The results of postural reduction of the fractures of the spine. J Bone Joint Surg Am 20 (3): 567.
Nicoll EA. Fracture-dislocation of the dorsolumbar spine. J Bone Joint Surg Br. 1949;31:376-394.
Holdsworth F. W. The Spinal Cord. Basic Aspects and Surgical Considerations. J Bone Joint Surg Br 1962 44-B: 968-969.
Kelly and T.E. Whitesides, Jr., Treatment of lumbodorsal fracture-dislocations. Ann Surg 167 (1968), pp. 705–709.
Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983 Nov-Dec;8(8):817-31.
McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am. 1983
Apr;65(4):461-73.
Ferguson RL, Allen BL Jr. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res. 1984 Oct;(189):77-88.
McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994 Aug 1;19(15):1741-4.
Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3(4):184-201.
Öner, FC, Ramos, LM, Simmermacher, RK, Kingma, PT, Diekerhof, CH, Dhert, WJ et al. (2002) "Classification of thoracic and lumbar spine fractures: problems of reproducibility: a study of 53 patients using CT and MRI"
Eur Spine J 11: 235-45
Vaccaro, AR, Zeiller, SC, Hulbert, RJ, Anderson, PA, Harris, M, Hedlund, R et al. (2005) "The thoracolumbar injury severity score: a proposed treatment algorithm" J Spinal Disord Tech 18: 209-15
Vaccaro AR, Lim MR, Hurlbert RJ, Lehman RA Jr, Harrop J, Fisher DC, Dvorak M, Anderson DG, Zeiller SC, Lee JY, Fehlings MG, Oner FC; Spine Trauma Study Group. Surgical decision making for unstable
thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Disord Tech. 2006 Feb;19(1):1-10.
Vaccaro AR, Baron EM, Sanfilippo J, Jacoby S, Steuve J, Grossman E, DiPaola M, Ranier P, Austin L, Ropiak R, Ciminello M, Okafor C, Eichenbaum M, Rapuri V, Smith E, Orozco F, Ugolini P, Fletcher M, Minnich J,
Goldberg G, Wilsey J, Lee JY, Lim MR, Burns A, Marino R, DiPaola C, Zeiller L, Zeiler SC, Harrop J, Anderson DG, Albert TJ, Hilibrand AS. Reliability of a novel classification system for thoracolumbar injuries: the
Thoracolumbar Injury Severity Score. Spine. 2006 May 15;31(11 Suppl):S62-9; discussion S104.
Anand N MD, Vaccaro AR MD, Lim MR MD, Lee JY MD, Arnold P MD, Harrop JS MD, Ratlif J MD, Rampersaud R MD, Bono CM MD. Evolution of Thoracolumbar Trauma Classification Systems: Assessing the Conflict
Between Mechanism and Morphology of Injury. Topics in Spinal Cord Injury Rehabilitation Volume 12, Number 1/Summer 2006 - Acute SCI Management: Basic Science and Nonoperative Care: 70-78.
Schweitzer KM Jr, Vaccaro AR, Lee JY, Grauer JN; Spine Trauma Study Group. Confusion regarding mechanisms of injury in the setting of thoracolumbar spinal trauma: a survey of The Spine Trauma Study Group (STSG).
J Spinal Disord Tech. 2006 Oct;19(7):528-30.
Harrop JS, Vaccaro AR, Hurlbert RJ, Wilsey JT, Baron EM, Shaffrey CI, Fisher CG, Dvorak MF, Oner FC, Wood KB, Anand N, Anderson DG, Lim MR, Lee JY, Bono CM, Arnold PM, Rampersaud YR, Fehlings MG; Spine
Trauma Study Group. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar
injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005. J Neurosurg Spine. 2006 Feb;4(2):118-22.
Vaccaro AR, Lee JY, Schweitzer KM Jr, Lim MR, Baron EM, Oner FC, Hulbert RJ, Hedlund R, Fehlings MG, Arnold P, Harrop J, Bono CM, Anderson PA, Anderson DG, Harris MB, Spine Trauma Study Group . Assessment
of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J. 2006 Sep-Oct;6(5):524-8. Epub 2006 Jul 11.
Lee JY; Vaccaro AR; Schweitzer KM; Lim MR; Baron EM; Rampersaud R; Oner F C; Hulbert R J; Hedlund R; Fehlings MG; Arnold P; Harrop J; Bono CM; Anderson PA; Patel A; Anderson D G; Harris MB Assessment of
injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography. The spine journal : official journal of the North American Spine Society 2007;7(4):422-7.
Lim M, Vaccaro AR, Lee J, Jacoby S, SanFilippo J, Oner FC, Hulbert J, Fehlings M, Arnold P, Harrop J, Bono C, Anderson P, Anderson DG, Baron E. The Thoracolumbar Injury Severity Scale and Score (TLISS): Interphysician and inter-disciplinary validation of a new paradigm for the treatment of thoracolumbar spine trauma, Coluna/Columna (Brazil), 5(3):157-64, 2006.
Patel AA, Vaccaro AR, Albert TJ, Hilibrand AS, Harrop JS, Anderson DG, Sharan A, Whang PG, Poelstra KA, Arnold P, Dimar J, Madrazo I, Hegde S. The adoption of a new classification system: time-dependent variation in
interobserver reliability of the thoracolumbar injury severity score classification system. Spine. 2007 Feb 1;32(3):E105-10.
Raja Rampersaud Y, Fisher C, Wilsey J, Arnold P, Anand N, Bono CM, Dailey AT, Dvorak M, Fehlings MG, Harrop JS, Oner FC, Vaccaro AR. Agreement between orthopedic surgeons and neurosurgeons regarding a new
algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study.J Spinal Disord Tech. 2006 Oct;19(7):477-82.
Ratliff J, Anand N, Vaccaro AR, Lim MR, Lee JY, Arnold P, Harrop JS, Rampersaud R, Bono CM, Gahr RH; Trauma Study Group Spine. Regional variability in use of a novel assessment of thoracolumbar spine fractures:
United States versus international surgeons. World J Emerg Surg. 2007 Sep 7;2:24.
Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon J, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute
spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990 May 17;322(20):1405-11.
Folman Y, Gepstein R. Late outcome of nonoperative management of thoracolumbar vertebral wedge fractures. J Orthop Trauma. 2003 Mar;17(3):190-2.
Ağuş H, Kayali C, Arslantaş M. Nonoperative treatment of burst-type thoracolumbar vertebra fractures: clinical and radiological results of 29 patients. Eur Spine J. 2005 Aug;14(6):536-40. Epub 2004 May 28.
Koller H, Acosta F, Hempfing A, Rohrmüller D, Tauber M, Lederer S, Resch H, Zenner J, Klampfer H, Schwaiger R, Bogner R, Hitzl W. Long-term investigation of nonsurgical treatment for thoracolumbar and lumbar burst
fractures: an outcome analysis in sight of spinopelvic balance. Eur Spine J. 2008 Aug;17(8):1073-95. Epub 2008 Jun 25.
Dai LY, Yao WF, Cui YM, Zhou Q. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma. 2004 Feb;56(2):348-55.
Thomas KC, Bailey CS, Dvorak MF, Kwon B, Fisher C. Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review. J Neurosurg Spine.
2006 May;4(5):351-8.
Dai LY, Wang XY, Jiang LS, Jiang SD, Xu HZ. Plain radiography versus computed tomography scans in the diagnosis and management of thoracolumbar burst fractures. Spine. 2008 Jul 15;33(16):E548-52.
Acosta FL Jr, Buckley JM, Xu Z, Lotz JC, Ames CP. Biomechanical comparison of three fixation techniques for unstable thoracolumbar burst fractures. Laboratory investigation. J Neurosurg Spine. 2008 Apr;8(4):341-6.
Disch AC, Knop C, Schaser KD, Blauth M, Schmoelz W. Angular stable anterior plating following thoracolumbar corpectomy reveals superior segmental stability compared to conventional polyaxial plate fixation. Spine. 2008
Jun 1;33(13):1429-37.
Whang PG, Vaccaro AR. Thoracolumbar fractures: anterior decompression and interbody fusion. J Am Acad Orthop Surg. 2008 Jul;16(7):424-31.
Gertzbein SD, Crowe PJ, Fazl M, Schwartz M, Rowed D. Canal clearance in burst fractures using the AO internal fixator. Spine. 1992 May;17(5):558-60.
McAfee PC, Bohlman HH. Complications following Harrington instrumentation for fractures of the thoracolumbar spine. J Bone Joint Surg Am. 1985 Jun;67(5):672-86.
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