Orthopedic Essentials - Spinal Trauma and Spine Classification ...
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Orthopedic Essentials - Spinal Trauma and Spine Classification 

DENIS THREE COLUMN CONCEPT

Anterior column:

    AAL: Anterior longitudinal ligament

    AAF: Anterior annulus fibrosus

Middle column:

    PLL: Posterior longitudinal ligament

    PAF: Posterior annulus fibrosus

Posterior column:

    SSL: Supraspinous ligament

    ISL: Interspinous ligament

    LF: Ligamentum flavum

    PC: Facet capsule 

DENIS CLASSIFICATION OF SPINAL TRAUMA: Compression Fracture, Burst Fracture, Chance Fracture

MINOR INJURIES

 • Transverse process fracture

 • Articular process fracture

 • Par interarticularis fracture

 • Spinous process fracture

Stable fractures: Don't cause spinal deformity or neurologic deficit, still able to weight bear

Unstable fractures: Unable to weight bear, may progress and causing further neurological and structural damage.

Criteria of unstable spine injury:

 • On palpation gap between 2 spinous processes increased

 • Neurological deficit

 • Vertebral compression >1/3

 • Vertebral displacement >1/3

 • Vertebral canal compromisation > 1/3

 • Bilateral facet joints dislocation

 • According to Denis 3 columns concept: 2 columns disrupted 

TLICS: Thoracolumbar Injury Classification and Severity Score

Morphology 

    0 No abnormality 

    1 Compression 

    2 + Burst fracture 

    3 Rotation/translation

    4 Distraction

Posterior Ligamentous complex (PLC)

    0 Intact

    2 Suspected / Indeterminate

    3 Injured

Neurological status

    0 Intact

    2 Root injury

    2 Complete cord / conus medullaris injury

    3 Incomplete cord / conus medullaris injury

    3 Cauda equina

Treatment

    TLICS <= 3: non-operative

    TLICS = 4: consider for operative or non-operative intervention

    TLICS >=5: operative



#Spinal #Fracture #Trauma #Spine #Classification #Orthopedics #diagnosis #localization
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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