Lateral spine X-ray showing osteoporotic wedge fractures of L1/2
CASH Orthosis.
A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury (or worsening of an already injured spine) if the fracture is unstable, that is, likely to change alignment without internal or external fixation.[1]
Distraction is where there is a pulling apart of the vertebrae.[2] Distraction injuries generally cause breaks in osseous and ligamentous supporting structures, and are therefore generally unstable.[3] A distraction injury on the posterior side of a vertebra can lead to a compression fracture on its anterior side.[3]
Thoracolumbar injury classification and severity score
The thoracolumbar injury classification and severity score (TLICS) is a scoring system to determine the need to surgically treat a spinal fracture of thoracic or lumbar vertebrae. The score is the sum of three values, each being the score of the most fitting alternative in three categories:[8]
A TLICS score of less than 4 indicates non-operative treatment, a score of 4 indicates that the injury may be treated operatively or non-operatively, while a score of more than 4 means that the injury is usually considered for operative management.[8]
AOSpine Thoracolumbar Injury Classification System
AOSpine Thoracolumbar Injury Classification System (ATLICS)[9] is the most recent classification scheme for thoracolumbar injuries.[10] ATLICS is broadly based on the TLICS system and has sufficient reliability irrespective of the experience of the observer.[10] ATLICS is primarily focused on fracture morphology, and has two additional sections addressing the neurological grading and clinical modifiers:[9]
Fracture morphology
Type A: Compression injuries (sub-types A0-A4)
Type B: Distraction injuries (sub-types B1-B3)
Type C: Translation injuries
Neurological status
N0: neurologically intact
N1: transient deficit
N2: radiculopathy
N3: "incomplete spinal cord injury or cauda equina injury"[9]
Osteoporosis is a condition causing weakening of the bone due to loss of bone substance. Women are about four times more likely to be affected by osteoporosis than men. Osteoporosis may occur after the menopause or as a result of malnutrition, hyperthyroidism, alcoholism, kidney disease. Osteoporosis may occur after treatment with antiepileptic drugs, proton pump inhibitors, antidepressants, corticosteroids or chemotherapy. Osteoporotic vertebral body compression fractures might occur even after minor trauma or while twisting, bending or coughing.
^Augustine, J.J. (21 November 2011). "Spinal trauma". In Campbell, J.R. (ed.). International Trauma Life Support for Emergency Care Providers. Pearson Education. ISBN978-0-13-300408-3.
^ abClark West, Stefan Roosendaal, Joost Bot and Frank Smithuis. "Spine injury - TLICS Classification". Radiology Assistant. Retrieved 2017-10-26.{{cite web}}: CS1 maint: multiple names: authors list (link)
^Saragiotto, Bruno T; Maher, Christopher G; Lin, Chung-Wei Christine; Verhagen, Arianne P; Goergen, Stacy; Michaleff, Zoe A (2018). "Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD012989. hdl:10453/128267. ISSN1465-1858.
^Page 94 and Page 126 in: Douglas L. Brockmeyer, Andrew T. Dailey (2016). Adult and Pediatric Spine Trauma, An Issue of Neurosurgery Clinics of North America. Vol. 28. Elsevier Health Sciences. ISBN9780323482844.
^Mirghasemi, Alireza; Mohamadi, Amin; Ara, Ali Majles; Gabaran, Narges Rahimi; Sadat, Mir Mostafa (November 2009). "Completely displaced S-1/S-2 growth plate fracture in an adolescent: case report and review of literature". Journal of Orthopaedic Trauma. 23 (10): 734–738. doi:10.1097/BOT.0b013e3181a23d8b. ISSN1531-2291. PMID19858983. S2CID6651435.
