THE ROLE OF MRI IN THE CLASSIFICATION OF THORACOLUMBAR SPINE INJURIES
Journal Title: Journal of Turkish Spinal Surgery - Year 2003, Vol 14, Issue 1
Abstract
Thoracolumbar spine fractures are complex injuries of a structure, which is compose of parts with different susceptibility to injury and different healing potentials. This complexity is reflected in the difficulties with the classification attempts and in the confusion in the literature about the effectiveness of different treatment regimes. Remarkable differences in the longterm results of conservative treatment regimes or surgical methods have been reported in the literature. These difficulties were probably caused by inadequate definition of some of the essential prognostic parameters. Since Holdsworth (1963), architectonic abstractions such as column have been used to comprehend these complex injuries and their mechanical consequences In the two-column spine of Holdsworth and the subsequent three column spine concepts of Louis (1977) and Denis (1983), the non-osseous structures of the spine were considered integral parts of these columns. The integrity of soft tissue structures, however, could only be inferred from indirect evidence from radiograms and later from CT scans. The Denis classification has been quite influential. Although this classification was a refinement in the understanding of the nature of these injuries, it was amenable to many simplifications and led to some persistent confusion. Although Denis emphasized that his columns are formed by osseous and non-osseous structures, no attempt has been made to progress the diagnosis of non-osseous injuries. The three-column concept was reduced to what is imagable with CT. It has been simplified and reduced to a simple rule of the thumb, which states that any injury to two of the three columns, as seen on CT, i.e. bony injury, make the spine unstable. Further, an intact middle column has been seen as a guarantee of stability, although Denis mentioned some of these lesions as first-degree unstable. Also the differentiation between the first, scond and third degree instability was lost, leading to a vague, poorly defined instability concept, which has remained dominant during the past decade.
Authors and Affiliations
Dr. F. C. Öner, MD, PhD
Keywords
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