Thoracolumbar Spine Trauma: Pearls and Pitfalls of the Newer Classification Systems

Patients who endure blunt trauma are commonly affected by thoracic and lumbar spinal fractures, which comprise approximately 50% of all vertebral fractures. Neurologic injury to the spinal cord occurs in 19% to 50% of these patients. Numerous classification systems have been developed to guide clinical and surgical treatment of thoracolumbar fractures. Currently, the two most commonly used classification systems in thoracolumbar spine trauma are the Arbeitsgemeinschaft für Osteosynthesefragen Spine Thoracolumbar Spine injury Classification System and the Thoracolumbar Injury Classification System. CT and MR imaging play complementary roles in the evaluation of spine injuries. The morphology of the injury is identified in the CT examinations, which also allows one to infer some of the soft-tissue injuries. MR imaging provides valuable information with regard to the soft tissues, including the ligamentous structures, the cord, and the extra-axial spaces. Unstable injuries evolve over time and represent a risk for developing or worsening of neurologic damage. Neuroradiologists should be aware of the clinical implications of using these classifications and how they can help improve patient outcome.

Learning Objectives: 1) To be familiar with the two most commonly used classification systems used in guiding clinical and surgical treatment of thoracolumbar fractures, including the limitations of both; 2) describe the roles of multidetector CT and MR imaging in the evaluation of spinal trauma, specifically, the respective strength of these imaging modalities in the assessment of bony and soft tissue injuries; 3) understand anatomy and biomechanics of the spine relevant to trauma, particularly the concept of the functional spinal unit; and 4) empower radiologists to help improve patient outcomes by incorporating concepts from the two most recent classifications into their daily practice of spinal trauma imaging, with prompt communication to the clinical team.