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Copyright ©The Author(s) 2015.
World J Radiol. Sep 28, 2015; 7(9): 253-265
Published online Sep 28, 2015. doi: 10.4329/wjr.v7.i9.253
Table 1 Subcategories of AO type A injury
Type A: Vertebral body compression
A1. Impaction fractures
A1.1. Endplate impaction
A1.2. Wedge impaction fractures
A1.2.1. Superior wedge impaction fracture
A1.2.2. Lateral wedge impaction fracture
A1.2.3. Inferior wedge impaction fracture
A1.3. Vertebral body collapse
A2. Split fractures
A2.1. Sagittal split fracture
A2.2. Coronal split fracture
A2.3. Pincer fracture
A3. Burst fractures
A3.1. Incomplete burst fracture
A3.1.1. Superior incomplete burst fracture
A3.1.2. Lateral incomplete burst fracture
A3.1.3. Inferior incomplete burst fracture
A3.2. Burst-split fracture
A3.2.1. Superior burst-split fracture
A3.2.2. Lateral burst-split fracture
A3.2.3. Inferior burst-split fracture
A3.3. Complete burst fracture
A3.3.1. Pincer burst fracture
A3.3.2. Complete flexion burst fracture
A3.3.3. Complete axial burst fracture
Table 2 Subcategories of AO type B injury
Type B: Anterior and posterior element injury with distraction
B1. Posterior disruption predominantly ligamentous (flexion-distraction injury)
B1.1. With transverse disruption of the disc
B1.1.1. Flexion-subluxation
B1.1.2. Anterior dislocation
B1.1.3. Flexion-subluxation/anterior dislocation with fracture of the articular processes
B1.2. With type A fracture of the vertebral body
B1.2.1. Flexion-subluxation + type A fracture
B1.2.2. Anterior dislocation + type A fracture
B1.2.3. Flexion-subluxation/anterior dislocation with fracture of the articular processes + type A fracture
B2. Posterior disruption predominantly osseous (flexion-distraction injury)
B2.1. Transverse bicolumn fracture
B2.2. With transverse disruption of the disc
B2.2.1. Disruption through the pedicle and disc
B2.2.2. Disruption through the parsinterarticularis and disc (flexion- spondylolysis)
B2.3. With type A fracture of the vertebral body
B2.3.1. Fracture through the pedicle + type A fracture
B2.3.2. Fracture through the parsinterarticularis (flexion-spondylolysis) + type A fracture
B3. Anterior disruption through the disc (hyperextension-shear injury)
B3.1. Hyperextension-subluxations
B3.1.1. Without injury of the posterior column
B3.1.2. With injury of the posterior column
B3.2. Hyperextension-spondylolysis
B3.3. Posterior dislocation
Table 3 Subcategories of AO type C injury
Type C: Anterior and posterior element injury with rotation
C1. Type A injuries with rotation(compression injuries with rotation)
C1.1. Rotational wedge fracture
C1.2. Rotational split fractures
C1.2.1. Rotational sagittal split fracture
C1.2.2. Rotational coronal split fracture
C1.2.3. Rotational pincer fracture
C1.2.4. Vertebral body separation
C1.3. Rotational burst fractures
C1.3.1. Incomplete rotational burst fractures
C1.3.2. Rotational burst-split fracture
C1.3.3. Complete rotational burst fracture
C2. Type B injuries with rotation
C2.1. B1 injuries with rotation (flexion-distraction injuries with rotation)
C2.1.1. Rotational flexion subluxation
C2.1.2. Rotational flexion subluxation with unilateral articular process fracture
C2.1.3. Unilateral dislocation
C2.1.4. Rotational anterior dislocation without/with fracture of articular processes
C2.1.5. Rotational flexion subluxation without/with unilateral articular process + type A fracture
C2.1.6. Unilateral dislocation + type A fracture
C2.1.7. Rotational anterior dislocation without/with fracture of articular processes + type A fracture
C2.2. B2 injuries with rotation (flexion distraction injuries with rotation)
C2.2.1. Rotational transverse bicolumn fracture
C2.2.2. Unilateral flexion spondylolysis with disruption of the disc
C2.2.3. Unilateral flexion spondylolysis + type A fracture
C2.3. B3 injuries with rotation (hyperextension-shear injuries with rotation)
C2.3.1. Rotational hyperextension-subluxation without/with fracture of posterior vertebral elements
C2.3.2. Unilateral hyperextension-spondylolysis
C2.3.3. Posterior dislocation with rotation
C3. Rotational-shear injuries
C3.1. Slice fracture
C3.2. Oblique fracture
Table 4 Thoracolumbar injury classification and severity score injury classification system
Injury categoryPoint value
Injury morphology
Compression1
Burst2
Translation or rotation3
Distraction4
PLC Status
Intact0
Injury suspected or indeterminate2
Injured3
Neurologic status
Intact0
Nerve root involvement2
Spinal cord or conusmedullaris injury
Incomplete2
Complete3
Cauda equina syndrome3
TLICS: Thoracolumbar injury classification and severity score; PLC: Posterior ligamentous complex.
Table 5 Surgical vs non-surgical decision system according to thoracolumbar injury classification and severity score classification
TLICS scoreTreatment recommendation
0-3Nonsurgical
4Nonsurgical or surgical
≥ 5Surgical
TLICS: Thoracolumbar injury classification and severity score.
Table 6 Surgical approach based on posterior ligamentous complex integrity
Neurologic statusSurgical approach
Intact PLCDisrupted PLC
Intact or nerve root injuryPosteriorPosterior
Incomplete cord injuryAnteriorCombined
Complete cord injuryAnterior or posteriorCombined or posterior
PLC: Posterior ligamentous complex.
Table 7 Check-list of findings to be reported on computed tomography[32]
Injury morphology
Primary injury pattern (compression, burst, translation, flexion-distraction)
Basic morphologic description of lesion
Vertebral height loss (approximate percentage)
Retropulsion with central spinal canal narrowing (approximate percentage)
Other contiguous or noncontiguous injuries
Degree of kyphosis
PLC injury predictors
Facet joint widening
Interspinous distance widening
Spinous process avulsion fracture
Vertebral body subluxation or dislocation
PLC: Posterior ligamentous complex; CT: Computed tomography.
Table 8 Checklist of findings to be evaluated on magnetic resonance imaging
Osseous (similar to injury morphology noted at CT) and soft tissue injuries
PLC status (intact, indeterminate, or disrupted)
Supraspinous ligament
Ligamentumflavum
Interspinous ligaments
Facet capsule
Disks
Anterior and posterior longitudinal ligaments
Neurologic injuries
Spinal cord and conusmedullaris
Cauda equina
Nerve root injury
Epidural hematoma
PLC: Posterior ligamentous complex; CT: Computed tomography.