Spinal fracture

A spinal fracture, also called a vertebral

fracture or a broken back, is a fracture
affecting the vertebrae of the spinal
column. Most types of spinal fracture
confer a significant risk of spinal cord
injury. After the immediate trauma, there is
a risk of spinal cord injury (or worsening of
an already injured spine) if the fracture is
unstable, that is, likely to change
alignment without internal or external
fixation.[1]

Spinal fracture

Other names Vertebral fracture,

broken back

Lateral spine X-ray showing osteoporotic

wedge fractures of L1/2
CASH Orthosis.

Types
Cervical fracture
Fracture of C1, including Jefferson
fracture
Fracture of C2, including Hangman's
fracture
 Flexion teardrop fracture – a
fracture of the anteroinferior aspect
of a cervical vertebra
Clay-shoveler fracture – fracture through
the spinous process of a vertebra
occurring at any of the lower cervical or
upper thoracic vertebrae
Burst fracture – in which a vertebra
breaks from a high-energy axial load
Compression fracture – a collapse of a
vertebra, often resulting in the form of a
wedge-shape due to larger compression
anteriorly
Chance fracture – compression injury to
the anterior portion of a vertebral body
with concomitant distraction injury to
posterior elements
Holdsworth fracture – an unstable
fracture dislocation of the
thoracolumbar junction of the spine
Distraction is where there is a pulling
apart of the vertebrae.[2] Distraction
injuries generally cause breaks in
osseous and ligamentous supporting
structures, and are therefore generally
unstable.[3] A distraction injury on the
posterior side of a vertebra can lead to a
compression fracture on its anterior
side.[3]
Cervical fracture
A medical history and physical
examination can be sufficient in clearing
the cervical spine. Notable clinical
prediction rules to determine which
patients need medical imaging are
Canadian C-spine rule and the National
Emergency X-Radiography Utilization
Study (NEXUS).[4]

The AO Foundation has developed a

descriptive system for cervical fractures,
the AOSpine subaxial cervical spine
fracture classification system.[5]
The indication to surgically stabilize a
cervical fracture can be estimated from
the Subaxial Injury Classification (SLIC).[6]

Thoracolumbar fracture
Vertebral fractures of the thoracic
vertebrae, lumbar vertebrae or sacrum are
usually associated with major trauma and
can cause spinal cord injury that results in
a neurological deficit.[7]

Thoracolumbar injury classification

and severity score

The thoracolumbar injury classification

and severity score (TLICS) is a scoring
system to determine the need to surgically
treat a spinal fracture of thoracic or
lumbar vertebrae. The score is the sum of
three values, each being the score of the
most fitting alternative in three
categories:[8]

Injury type

Compression fracture - 1 point

Burst fracture - 2 points
Translational rotational injury - 3 points
Distraction injury - 4 points

Posterior ligamentous complex

Intact - 0 points
 Suspected injury or indeterminate - 2
points
Injured - 3 points

Neurology

Intact - 0 points
Spinal nerve root injury - 2 points
Incomplete injury of cord/conus
medullaris - 3 points
Complete injury of cord/conus
medullaris (complete) - 2 points
Cauda equina syndrome - 3 points

A TLICS score of less than 4 indicates non-

operative treatment, a score of 4 indicates
that the injury may be treated operatively
or non-operatively, while a score of more
than 4 means that the injury is usually
considered for operative management.[8]

AOSpine Thoracolumbar Injury

Classification System

AOSpine Thoracolumbar Injury

Classification System (ATLICS)[9] is the
most recent classification scheme for
thoracolumbar injuries.[10] ATLICS is
broadly based on the TLICS system and
has sufficient reliability irrespective of the
experience of the observer.[10] ATLICS is
primarily focused on fracture morphology,
and has two additional sections
addressing the neurological grading and
clinical modifiers:[9]

Fracture morphology

Type A: Compression injuries (sub-types

A0-A4)
Type B: Distraction injuries (sub-types
B1-B3)
Type C: Translation injuries

Neurological status

N0: neurologically intact

N1: transient deficit
N2: radiculopathy
 N3: "incomplete spinal cord injury or
cauda equina injury"[9]
N4: "complete spinal cord injury"[9]
NX: unknown neurological status

Modifiers

M1: unknown tension band injury status

M2: comorbidities

Osteoporotic vertebral
compression fracture
Osteoporosis is a condition causing
weakening of the bone due to loss of bone
substance. Women are about four times
more likely to be affected by osteoporosis
than men. Osteoporosis may occur after
the menopause or as a result of
malnutrition, hyperthyroidism, alcoholism,
kidney disease. Osteoporosis may occur
after treatment with antiepileptic drugs,
proton pump inhibitors, antidepressants,
corticosteroids or chemotherapy.
Osteoporotic vertebral body compression
fractures might occur even after minor
trauma or while twisting, bending or
coughing.

Sacral fracture

References
1. "Fracture" (https://www.mdguidelines.co
m/easyaccess/fracture/definition) .
 MDguidelines by the American Medical
Association. Retrieved 2017-10-26.
2. Augustine, J.J. (21 November 2011).
"Spinal trauma" (https://books.google.co
m/books?id=ubkuAAAAQBAJ) . In
Campbell, J.R. (ed.). International Trauma
Life Support for Emergency Care
Providers. Pearson Education. ISBN 978-0-
13-300408-3.
3. Clark West, Stefan Roosendaal, Joost Bot
and Frank Smithuis. "Spine injury - TLICS
Classification" (http://www.radiologyassist
ant.nl/en/p54885e620ee46/spine-injury-tli
cs-classification.html) . Radiology
Assistant. Retrieved 2017-10-26.
4. Saragiotto, Bruno T; Maher, Christopher G;
Lin, Chung-Wei Christine; Verhagen,
 Arianne P; Goergen, Stacy; Michaleff, Zoe
A (2018). "Canadian C-spine rule and the
National Emergency X-Radiography
Utilization Study (NEXUS) for detecting
clinically important cervical spine injury
following blunt trauma". Cochrane
Database of Systematic Reviews.
doi:10.1002/14651858.CD012989 (http
s://doi.org/10.1002%2F14651858.CD0129
89) . hdl:10453/128267 (https://hdl.handl
e.net/10453%2F128267) . ISSN 1465-
1858 (https://www.worldcat.org/issn/146
5-1858) .
5. "Classification" (https://www2.aofoundati
on.org/wps/portal/!ut/p/a0/04_Sj9CPykss
y0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz
9_UMMDRyDXQ3dw9wMDAx8jfULsh0VAd
 AsNSU!/?bone=Spine&segment=TraumaL
owerCervical&soloState=lyteframe&conte
ntUrl=srg/popup/additional_material/52/X
001_Classification.jsp) . AO Foundation.
Retrieved 2019-05-08.
6. Page 94 (https://books.google.com/book
s?id=r_gTDgAAQBAJ&pg=PA94) and
Page 126 (https://books.google.com/boo
ks?id=r_gTDgAAQBAJ&pg=PA126) in:
Douglas L. Brockmeyer, Andrew T. Dailey
(2016). Adult and Pediatric Spine Trauma,
An Issue of Neurosurgery Clinics of North
America. Vol. 28. Elsevier Health
Sciences. ISBN 9780323482844.
7. Mirghasemi, Alireza; Mohamadi, Amin;
Ara, Ali Majles; Gabaran, Narges Rahimi;
Sadat, Mir Mostafa (November 2009).
 "Completely displaced S-1/S-2 growth
plate fracture in an adolescent: case
report and review of literature". Journal of
Orthopaedic Trauma. 23 (10): 734–738.
doi:10.1097/BOT.0b013e3181a23d8b (htt
ps://doi.org/10.1097%2FBOT.0b013e3181
a23d8b) . ISSN 1531-2291 (https://www.w
orldcat.org/issn/1531-2291) .
PMID 19858983 (https://pubmed.ncbi.nl
m.nih.gov/19858983) . S2CID 6651435 (h
ttps://api.semanticscholar.org/CorpusID:6
651435) .
8. Buck Christensen. "Thoracolumbar Injury
Classification and Severity (TLICS) Scale"
(https://emedicine.medscape.com/articl
e/2172540-overview) . Medscape.
 Retrieved 2017-10-26. Updated: Dec 09,
2014
9. Vaccaro, Alexander R.; Oner, Cumhur;
Kepler, Christopher K.; Dvorak, Marcel;
Schnake, Klaus; Bellabarba, Carlo;
Reinhold, Max; Aarabi, Bizhan; Kandziora,
Frank (November 2013). "AOSpine
Thoracolumbar Spine Injury Classification
System". Spine. 38 (23): 2028–2037.
doi:10.1097/brs.0b013e3182a8a381 (http
s://doi.org/10.1097%2Fbrs.0b013e3182a8
a381) . ISSN 0362-2436 (https://www.wor
ldcat.org/issn/0362-2436) .
PMID 23970107 (https://pubmed.ncbi.nl
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 10. Abedi, Aidin; Mokkink, Lidwine B; Zadegan,
Shayan A; Paholpak, Permsak; Tamai, Koji;
Wang, Jeffrey C; Buser, Zorica (October
2018). "Reliability and Validity of the
AOSpine Thoracolumbar Injury
Classification System: A Systematic
Review." Global Spine Journal.
2192568218806847.
doi:10.1177/2192568218806847.

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