Luiz Roberto Vialle, et al.

 AOSspine Masters Series. V. 6., Thoracolumbar Spine Trauma.

New York, Thieme, 2016. (Luiz Roberto Vialle et al. 2016)

Fractures of the spinal column are a common

musculoskeletal injury, occurring nearly
150,000 times annually.1 Of these, the majority
are in the thoracic or lumbar spine, and 75 to
90% are within the thoracolumbar junction.1–3
Because of the frequency and potential severity
of these injuries, a reliable and reproducible
classification scheme that is both descriptive
and helpful in determining the appropriate
treatment is imperative. Several classification
schemes have been developed for these injuries.
4–8 However, these schemes have poor reproducibility,
little prognostic value, and a high
level of complexity; for these reasons, and despite
numerous attempts, none of these schemes
has gained widespread acceptance.3,9,10
The historical classification schemes can
largely be grouped into either mechanistic or
morphological classifications. Of the morphological
schemes, the Magerl5 comprehensive
classification, based on the AO classification for
extremity fractures, is the most descriptive.
Fractures are grouped into three mechanistic
categories: compression, distraction, and translation.
Each category is divided into three groups
that are further subdivided to produce the final
injury type. Although this classification is universally
considered highly detailed, and it provides
the most information regarding fracture
anatomy, it has been criticized for being cumbersome
and not appropriate for practical use.
The AOSpine Thoracolumbar Classification
represents a hybrid of the TLICS and Magerl
classifications that combines the strengths of
each scheme.11,12 Primarily, it provides a detailed
yet simplified description of the fracture
morphology, roughly based on what was previously
described by Magerl. Additionally, it incorporates
the neurologic status of the patient
and the integrity of the PLC into the overall
rating scheme, similar to the TLICS system and
critical for clinical decision making. This chapter
describes the derivation of this classification
and discusses the methodology for grading
injuries with this classification.