Classification of spinal fractures by type
(A) Classification according to the mechanism of spinal trauma
There are four types:
1, simple compression fracture
This type of injury is mainly caused by flexion compression stress, according to the direction of bending can be divided into flexion compression and lateral compression, the former is more common, the latter is rare, the former shows that the anterior column is under pressure, the anterior part of the vertebral body is highly compressed <50%, the anterior longitudinal ligament is mostly intact, the posterior column is under tension, the X-ray image shows that the posterior cortex of the vertebral body is intact, the height is unchanged, the supraspinous and interspinous ligaments of the posterior column can be ruptured when the tension is high, and the middle column as The supraspinous and interspinous ligaments of the posterior column can rupture under high tension, and the middle column is not involved as a fulcrum or hub.
2. Burst fracture
This type of fracture is often classified as a compression fracture before the application of CT scan. This type of injury is characterized by the involvement of the middle column of the spine, and the vertebral body is cracked under axial stress or axial stress with flexion stress, and the posterior fracture fragment of the vertebral body often protrudes into the spinal canal together with the disc tissue, causing spinal stenosis and spinal cord or cauda equina injury. CT scans have the greatest diagnostic value for this type of injury.
Denis classifies burst fractures into five types.
Type A, a fracture in which both the upper and lower endplates rupture due to severe complete longitudinal vertical stress, generally without causing posterior convexity into an angle, is most common in the lower lumbar spine. type B, an injury to the upper endplate due to incomplete longitudinal vertical or slightly anterior flexion stress, can cause acute or late posterior angulation, and is the most common type of thoracolumbar burst fracture. type C, an injury to the lower endplate, has a similar mechanism of action to type B, but is less common than type B. type D, an injury to the axial endplate, is less common than type B. Type D, which is caused by axial stress with rotational violence, is found in the lumbar spine and is extremely unstable and can cause fracture dislocation, but differs from flexion-rotation fractures in that the vertebral body is mostly comminuted, the spacing between the pedicles is widened, the posterior wall of the vertebral body can protrude into the spinal canal, and the vertebral plate can have longitudinal fractures. spinal canal.
3, seat belt type injury
This type for the tensional shear injury, is a posterior column structure horizontal shear accompanied by flexion stress injury, the posterior column, the middle column is a tensional injury, supraspinal, interspinous, yellow ligament and even posterior longitudinal ligament rupture, the anterior column is axial flexion, compression can occur, but also can be stranded chain effect without injury. This type of mild injury is a stable type, generally without spinal stenosis. In severe cases, the vertebral body may be slice-like fracture, arch root fracture, with horizontal displacement, fracture instability, spinal cord injury is also more serious.
4, fracture dislocation type
This type of injury is caused by severe violence, the mechanism is more complex, can be caused by flexion, shear, tension or rotation and other compound stress, so in the past, according to the different violence is divided into flexion and rotation type, shear type or tension type. This type of injury often involves the three columns, resulting in different degrees of spinal cord or nerve injury.
(B) according to the scope of injury involved in the classification
Three-column structural classification.
Denis understands the spine as three longitudinal columnar structures, namely: (1) anterior column, including the anterior 2/3 part of the anterior longitudinal ligament, vertebral body and intervertebral disc of the spine; (2) middle column, consisting of the posterior 1/3 of the vertebral body and intervertebral disc and posterior longitudinal ligament; (3) posterior column, consisting of the arch, lamina, attachments and ligamentum flavum, interspinous and supraspinous ligaments.
(C) Classification according to the degree of spinal canal stenosis or blockage
Wolter divided the cross-section of the spinal canal by CT scan into three equal parts and used 0, 1, 2, and 3 to indicate the index of stenosis and obstruction. (1) 0 for no stenosis or no obstruction of the spinal canal; (2) 1 for compression or stenosis of the spinal canal in 1/3 of the cross-section; (3) 2 for compression or stenosis of the spinal canal in 2/3 of the cross-section; and (4) 3 for complete compression or obstruction of the spinal canal. The Denis three-column structural classification can express the extent of spinal involvement and stability, but does not reflect the involvement of the spinal canal. Therefore, we suggest a comprehensive classification that integrates the mechanism of trauma, extent of involvement, and spinal canal, which is more clinically relevant for treatment planning and prognosis. The comprehensive classification method is as follows: simple compression fracture is represented by “C”, burst fracture is represented by “B”, safety belt type injury is represented by “S”, fracture dislocation is represented by “F”; anterior, middle The anterior, middle and posterior columns are represented by a, m and p, respectively; 0, 1, 2 and 3 are the spinal canal compression indices. For example, the patient is a 36-year-old male who was involved in a car accident, and the X-ray examination shows a T12-L1 fracture dislocation, and the CT scan shows that 1/3 of the spinal canal is compressed and the fracture involves three columns.
Burst fractures are often classified as compression fractures before the application of CT scans. In severe cases, the vertebral body may be split in a slice-like pattern, with fracture of the pedicle with horizontal displacement, fracture instability, and more severe spinal cord injury. The comprehensive classification method is: simple compression fracture is represented by “C”, burst fracture is represented by “B”, safety belt type injury is represented by “S”, and fracture dislocation is represented by “F”;
Second, the neurological and functional classification of spinal cord injury
ASIA spinal cord damage classification
The development of neurological and functional classification of spinal cord injury is of great importance in determining the degree of spinal cord injury, assessing the effectiveness of treatment and proper communication between clinical and research workers. The most widely accepted and used classification is the 1992 American Spinal Cord Injury Association (ASIA) revised classification based on the Frankel classification. There is no functional preservation of sensation and movement below the level of spinal cord injury, including the sacral segment (S4 to S5). There is sensory function below the plane of injury, including the sacral segment (S4-S5), but no motor function.C, Incomplete impairment. Sensory and motor function exist below the plane of the injured nerve, but the muscle strength of most of the guarding muscles is below grade 3. D, Incomplete impairment. Sensory and motor functions exist below the plane of injury, and the muscle strength of most of the key muscles is equal to or greater than grade 3. E, normal sensory and motor functions are normal.