European Spine Journal

, Volume 19, Supplement 1, pp 2–7 | Cite as

Classification of thoracolumbar fractures and dislocations

  • Max Aebi
Review Article


A classification of injuries is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been proposed, the most frequently used is the Denis classification. The problem of this classification system is that it is based on an assumption, which is anatomically unidentifiable: the so-called middle column. For this reason, few years ago, a group of spine surgeons has developed a new classification system, which is based on the severity of the injury. The severity is defined by the pathomorphological findings, the prognosis in terms of healing and potential of neurological damage. This classification is based on three major groups: A = isolated anterior column injuries by axial compression, B = disruption of the posterior ligament complex by distraction posteriorly, and group C = corresponding to group B but with rotation. There is an increasing severity from A to C, and within each group, the severity usually increases within the subgroups from .1, .2, .3. All these pathomorphologies are supported by a mechanism of injury, which is responsible for the extent of the injury. The type of injury with its groups and subgroups is able to suggest the treatment modality.


Thoracolumbar fracture Fracture-dislocation Spine injury Spinal fracture Classification 


Conflict of interest statement

None of the authors has any potential conflict of interest.


  1. 1.
    Chance QC (1948) Note on a type of flexion fracture of the spine. Br J Radiol 21:452–453CrossRefPubMedGoogle Scholar
  2. 2.
    Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831CrossRefPubMedGoogle Scholar
  3. 3.
    Ferguson RL, Allen BL Jr (1984) A mechanistic classification of thoracolumbar spine fractures. Clin Orthop 189:77–88PubMedGoogle Scholar
  4. 4.
    Gertzbein SD, Court-Brown CM (1988) Flexion/distraction injuries of the lumbar spine. Mechanisms of injury and classification. Clin Orthop 227:52–60PubMedGoogle Scholar
  5. 5.
    Groves CJ, Cassar-Pullicino VN, Tins BJ, Tyrrell PNM, McCall IW (2005) Chance-type flexion-distraction injuries in the thoracolumbar spine: MR imaging characteristics. Radiology 236:601–608CrossRefPubMedGoogle Scholar
  6. 6.
    Grunhagen J, Egbers HJ, Heller M, Reuter M (2005) Comparison of spine injuries by means of CT and MRI according to the classification of Magerl. Rofo 177(6):828–834PubMedGoogle Scholar
  7. 7.
    Holdsworth FW (1963) Fractures, dislocations, and fracture dislocations of the spine. J Bone Joint Surg [Br] 45:6–20Google Scholar
  8. 8.
    Jeanneret B, Ward J-C, Magerl F (1993) Pincer fractures: a therapeutic quandary. Rev Chir Orthop 79(spécial):Abstract 38Google Scholar
  9. 9.
    Keynan O, Fisher CG, Vaccaro A, Fehlings MG, Oner FC, Dietz J, Kwon B, Rampersaud R, Bono C, France J, Dvorak M (2006) Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group. Spine 31(5):E156–E165CrossRefPubMedGoogle Scholar
  10. 10.
    Leibl T, Funke M, Dresing K, Grabbe E (1999) Instability of spinal fractures—therapeutic relevance of different classifications. Rofo 170(2):174–180PubMedGoogle Scholar
  11. 11.
    Louis R (1977) Les théories de l’instabilité. Rev Chir Orthop 63:423–425PubMedGoogle Scholar
  12. 12.
    Magerl F, Harms J, Gertzbein SD, Aebi M, Nazarian S (1990) A new classification of spinal fractures. Presented at the Societé Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) Meeting, Montreal, September 9, 1990Google Scholar
  13. 13.
    Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201CrossRefPubMedGoogle Scholar
  14. 14.
    McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 65:461–479PubMedGoogle Scholar
  15. 15.
    Nicoll EA (1949) Fractures of the dorso-lumbar spine. J Bone Joint Surg Br 31:376–394Google Scholar
  16. 16.
    Oner FC, van Gils AP, Dhert WJ, Verbout AJ (1999) MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures. Skeletal Radiol 28(8):433–443CrossRefPubMedGoogle Scholar
  17. 17.
    Oner FC, Ramos LM, Simmermacher RK, Kingma PT, Diekerhof CH, Dhert WJ, Verbout AJ (2002) Classification of thoracic and lumbar spine fractures: problems of reproducibility. A study of 53 patients using CT and MRI. Eur Spine J 11(3):235–245CrossRefPubMedGoogle Scholar
  18. 18.
    Rennie W, Mitchell N (1973) Flexion distraction injuries of the thoracolumbar spine. J Bone Joint Surg Am 55:386–390PubMedGoogle Scholar
  19. 19.
    Roy-Camille R, Saillant G, Berteaux D, Marie-Anne S (1979) Early management of spinal injuries. In: McKibbin B (ed) Recent advances in orthopaedics, vol 3. Churchill Livingstone, Edinburgh, pp 57–87Google Scholar
  20. 20.
    Smith WS, Kauter H (1969) Patterns and mechanics of lumbar injuries associated with lap seat belts. J Bone Joint Surg Am 51:239–254PubMedGoogle Scholar
  21. 21.
    Vaccaro AR, Zeiller SC, Hulbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Lehman RA Jr, Anderson DG, Bono CM, Kuklo T, Oner FC (2005) The thoracolumbar injury severity score: a proposed treatment algorithm. J Spinal Disord Tech 18(3):209–215PubMedGoogle Scholar
  22. 22.
    Whitesides TE Jr (1977) Traumatic kyphosis of the thoracolumbar spine. Clin Orthop 128:78–92PubMedGoogle Scholar
  23. 23.
    Wood KB, Khanna G, Vaccaro AR, Arnold PM, Harris MB, Mehbod AA (2005) Assessment of two thoracolumbar fracture classification systems as used by multiple surgeons. J Bone Joint Surg Am 87:1423–1429CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.MEM Research Center for Orthopaedic Surgery, Institute for Evaluative Research in Orthopaedic SurgeryUniversity of BerneBernSwitzerland

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