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CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0045-1805025
Review Article

Spine Trauma Classifications: Historical, Current, and Emerging Perspectives for Radiologists

Khanak Nandolia
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Sonal Saran 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Garima Varshney
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Kapil Shirodkar
2   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Karthikeyan P. Iyengar 
3   Department of Orthopaedics, Southport and Ormskirk Hospitals, National Health Service Trust, Southport, United Kingdom
,
Rajesh Botchu
2   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
› Author Affiliations
Funding None.
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Abstract

The spine serves as a protective, load-bearing, and stabilizing axis for the body. Trauma can cause significant damage to spinal structures, potentially resulting in severe neurological dysfunction and disabilities such as paraplegia or quadriplegia. Early and accurate diagnosis of these injuries is important, with computed tomography and magnetic resonance imaging being important for recognizing these injuries and guiding timely treatment to minimize disability. Radiologists play a critical role in assessing spine trauma to determine stability, which informs the need for nonoperative or operative management. Trauma classification systems are vital for uniform communication between radiologists and surgeons, aiding in decision-making. Various classifications exist for cervical, thoracolumbar, and sacral trauma, each with advantages and limitations. Understanding these classification systems is essential for guiding diagnosis, treatment, and prognostication. Over the years, these systems have evolved, reflecting advancements in medical knowledge, imaging technology, and clinical practices. Contemporary classification systems have addressed the limitations of previous systems. Vaccaro et al proposed the “Thoracolumbar Injury Classification and Severity Score (TLICS)” in 2005 and the “Subaxial Cervical Spine Injury Classification System” in 2007. These classifications focus on injury morphology, the integrity of the posterior ligamentous complex or discoligamentous complex, and the patient's neurologic status. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) founded the “Spine Classification Group” to review the “AO-Magerl classification” and create an extensive system for the whole spine. This system focuses on fracture morphology, neurological status, clinical modifiers, and facet joint injury. The TLICS system is straightforward and easy to use in clinical practice, while the AOSpine system is more comprehensive and reliable. As classification systems evolve, collaboration among radiologists, spine surgeons, and researchers will be essential. By embracing advancements in imaging technology and incorporating new clinical data, the field of spine trauma classification can achieve greater accuracy and consistency, ultimately enhancing patient care and outcomes.

Keywords

spine trauma - TLICS - AO - CT - MRI

Authors' Contributions

K.N.: Original draft preparation.

S.S.: Conceptualization, reviewing, editing, and supervision of the work.

G.V., K.S., and K.P.I.: Resources, writing—review, and editing processes.

R.B.: Revision after reviewing by coauthors.

All authors approved the final version before submission.




Publication History

Article published online:
27 February 2025

© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 de Almeida Prado RM, de Almeida Prado JLM, Yamada AF. et al. Spine trauma: radiological approach and new concepts. Skeletal Radiol 2021; 50 (06) 1065-1079
    CrossrefPubMedSearch in Google Scholar
  • 2 Khurana B, Sheehan SE, Sodickson A, Bono CM, Harris MB. Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics 2013; 33 (07) 2031-2046
    CrossrefPubMedSearch in Google Scholar
  • 3 Divi SN, Schroeder GD, Oner FC. et al. AOSpinedspine trauma classification system: the value of modifiers: a narrative review with commentary on evolving descriptive principles. Global Spine J 2019; 9 (01) 77-88
    CrossrefPubMedSearch in Google Scholar
  • 4 Aebi M. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J 2010; 19 (Suppl 1, Suppl 1): S33-S39
    CrossrefPubMedSearch in Google Scholar
  • 5 Anand N. Section 5: back. In: Standring S. ed. Gray's Anatomy. 41st ed. Philadelphia: Elsevier; 2016: 710e62
    Search in Google Scholar
  • 6 White III AA, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop Relat Res 1975; (109) 85-96
    PubMedSearch in Google Scholar
  • 7 Allen Jr BL, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 1982; 7 (01) 1-27
    CrossrefPubMedSearch in Google Scholar
  • 8 Harris TJ, Blackmore CC, Mirza SK, Jurkovich GJ. Clearing the cervical spine in obtunded patients. Spine 2008; 33 (14) 1547-1553
    CrossrefPubMedSearch in Google Scholar
  • 9 Anderson PA, Moore TA, Davis KW. et al; Spinal Trauma Study Group. Cervical spine injury severity score. Assessment of reliability. J Bone Joint Surg Am 2007; 89 (05) 1057-1065
    CrossrefPubMedSearch in Google Scholar
  • 10 Bohler J. Conservative treatment of fractures of the capitulum of humerus [in German]. Arch Orthop Unfallchir 1956; 48 (03) 323-325
    PubMedSearch in Google Scholar
  • 11 Watson-Jones R. The results of postural reduction of fractures of the spine. J Bone Joint Surg 1938; 20 (03) 567-586
    Search in Google Scholar
  • 12 Kelly RP, Whitesides Jr TE. Treatment of lumbodorsal fracture-dislocations. Ann Surg 1968; 167 (05) 705-717
    CrossrefPubMedSearch in Google Scholar
  • 13 Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 1970; 52 (08) 1534-1551
    CrossrefPubMedSearch in Google Scholar
  • 14 Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983; 8 (08) 817-831
    CrossrefPubMedSearch in Google Scholar
  • 15 McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 1983; 65 (04) 461-473
    CrossrefPubMedSearch in Google Scholar
  • 16 Ferguson RL, Allen Jr BL. A mechanistic classification of thoracolumbar spine fractures. Clin Orthop Relat Res 1984; (189) 77-88
    PubMedSearch in Google Scholar
  • 17 McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine 1994; 19 (15) 1741-1744
    CrossrefPubMedSearch in Google Scholar
  • 18 Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994; 3 (04) 184-201
    CrossrefPubMedSearch in Google Scholar
  • 19 Vaccaro AR, Lehman Jr RA, Hurlbert RJ. et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 2005; 30 (20) 2325-2333
    CrossrefPubMedSearch in Google Scholar
  • 20 Vaccaro AR, Hulbert RJ, Patel AA. et al; Spine Trauma Study Group. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine 2007; 32 (21) 2365-2374
    CrossrefPubMedSearch in Google Scholar
  • 21 Vaccaro AR, Oner C, Kepler CK. et al; AOSpine Spinal Cord Injury & Trauma Knowledge Forum. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 2013; 38 (23) 2028-2037
    CrossrefPubMedSearch in Google Scholar
  • 22 Vaccaro AR, Koerner JD, Radcliff KE. et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J 2016; 25 (07) 2173-2184
    CrossrefPubMedSearch in Google Scholar
  • 23 Schömig F, Taheri N, Kalaf H, Muellner M, Becker L, Pumberger M. Validation of the TLICS and AOSpine injury score for surgical management of paediatric traumatic spinal injuries. Arch Orthop Trauma Surg 2023; 143 (04) 2011-2017
    CrossrefPubMedSearch in Google Scholar
  • 24 Dauleac C, Mottolese C, Beuriat PA, Szathmari A, Di Rocco F. Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population. Eur Spine J 2021; 30 (10) 3036-3042
    CrossrefPubMedSearch in Google Scholar
  • 25 Pishnamaz M, Balosu S, Curfs I. et al. Reliability and agreement of different spine fracture classification systems: an independent intraobserver and interobserver study. World Neurosurg 2018; 115: e695-e702
    CrossrefPubMedSearch in Google Scholar
  • 26 Kaul R, Chhabra HS, Vaccaro AR. et al. Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study. Eur Spine J 2017; 26 (05) 1470-1476
    CrossrefPubMedSearch in Google Scholar
  • 27 Abedi A, Mokkink LB, Zadegan SA. et al. Reliability and validity of the AOSpine thoracolumbar injury classification system: a systematic review. Global Spine J 2019; 9 (02) 231-242
    CrossrefPubMedSearch in Google Scholar
  • 28 An Z, Zhu Y, Wang G, Wei H, Dong L. Is the thoracolumbar AOSpine Injury Score superior to the Thoracolumbar Injury Classification and Severity Score for guiding the treatment strategy of thoracolumbar spine injuries?. World Neurosurg 2020; 137: e493-e498
    CrossrefPubMedSearch in Google Scholar
  • 29 Shanmuganathan K, Gullapalli RP, Zhuo J, Mirvis SE. Diffusion tensor MR imaging in cervical spine trauma. AJNR Am J Neuroradiol 2008; 29 (04) 655-659
    CrossrefPubMedSearch in Google Scholar
  • 30 Cheran S, Shanmuganathan K, Zhuo J. et al. Correlation of MR diffusion tensor imaging parameters with ASIA motor scores in hemorrhagic and nonhemorrhagic acute spinal cord injury. J Neurotrauma 2011; 28 (09) 1881-1892
    CrossrefPubMedSearch in Google Scholar
  • 31 Endo T, Suzuki S, Utsunomiya A, Uenohara H, Tominaga T. Prediction of neurological recovery using apparent diffusion coefficient in cases of incomplete spinal cord injury. Neurosurgery 2011; 68 (02) 329-336
    CrossrefPubMedSearch in Google Scholar
  • 32 Hornung AL, Hornung CM, Mallow GM. et al. Artificial intelligence and spine imaging: limitations, regulatory issues and future direction. Eur Spine J 2022; 31 (08) 2007-2021
    CrossrefPubMedSearch in Google Scholar
  • 33 Hornung AL, Hornung CM, Mallow GM. et al. Artificial intelligence in spine care: current applications and future utility. Eur Spine J 2022; 31 (08) 2057-2081
    CrossrefPubMedSearch in Google Scholar