OBJECTIVETo explore the surgical treatment and classification of multiple-level noncontiguous thoracolumbar fractures.

METHODSFrom December 2005 to December 2008, 24 patients with multiple-level noncontignous thoracolumbar fractures were treated by surgical operation included 16 males and and 8 females with a mean age of 36 years old ranging from 18 to 63 years. According to the ASIA grade of spinal nerve function there was 1 case in grade A, 2 cases in grade B, 2 cases in grade C, 8 cases in grade D and 11 cases in grade E. Based on the modified classification of multiple-level noncontiguous spinal fractures (MNSF) there were 15 cases of type A,9 of type B. The fracture involved 48 vertebraes ranged from T6 to L4. Radiographic data were analyzed retrospectively.

RESULTSAll patients achieved surgical treatment without missed diagnosis or delayed diagnosis. All cases were followed up for from 3 to 36 months (means 18.3 months). All cases achieved bone fusion, without significantly lose of the vertebrae body height and implant failure. Among 13 patients with spinal nerves injuries before operation, 11 got more than one grade improvement of the ASIA grading, 2 remained unchanged.

CONCLUSIONThe traditional classification methods are improved to guide treatment. The treatment of multiple-level noncontiguous thoracolumbar fractures should be determined according to the severity of spinal cord injury, the stability and the types of spine fractures.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Spinal Fractures ; classification ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

PURPOSE: The proposed the thoracolumbar injury classification system (TLICS) for thoracolumbar injury cites the integrity of the posterior ligamentous complex (PLC). However, no report has elucidated the severity of damage in thoracic and lumbar injury with classification schemes by presence of the PLC injury. The purpose of this study was to accurately assess the severity of damage in thoracic and lumbar burst fractures with the PLC injuries. MATERIALS AND METHODS: One hundred consecutive patients treated surgically for thoracic and lumbar burst fractures were enrolled in this study. There were 71 men and 29 women whose mean age was 36 years. Clinical and radiologic data were investigated, and the thoracolumbar injury classification schemes were also evaluated. All patients were divided into two groups (the P group with PLC injuries and the C group without PLC injuries) for comparative examination. RESULTS: Fourth-one of 100 cases showed PLC injuries in MRI study. The load sharing classification score was significantly higher in the P group [7.8+/-0.2 points for the P group and 6.9+/-1.1 points for the C group (p<0.001)]. The TLICS (excluded PLC score) score was also significantly higher in the P group [6.2+/-1.1 points for the P group and 4.0+/-1.4 points for the C group (p<0.001)]. CONCLUSION: The presence of PLC injury significantly influenced the severity of damage. In management of thoracic lumbar burst fractures, evaluation of PLC injury is important to accurately assess the severity of damage.
Adolescent ; Adult ; Aged ; Female ; Humans ; Ligaments, Articular/*injuries ; Lumbar Vertebrae/*injuries ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures/*classification/*physiopathology/surgery ; Thoracic Vertebrae/*injuries ; Young Adult