The information below is contained in papers found in the literature search carried out to inform this clinical decision making tool.

View the multiple fracture levels pathway

Odontoid Peg Fracture Classification / D’Alonso & Anderson classification

Type I

• rare
• fracture of the upper part of the odontoid peg
• above the level of the transverse band of the cruciform ligament
• usually considered stable

Type II

• most common
• fracture at the base of the odontoid peg
• below the level of the transverse band of the cruciform ligament
• unstable
• high risk of non-union

Type III

• through the odontoid peg and into the lateral masses of C2
• relatively stable if not excessively displaced
• best prognosis for healing because of the larger surface area of the fracture

Hangman / Pedicle Fracture Classification

Levine and Edwards classification is used to classify Hangman Fractures of C2 (also known as traumatic spondylolisthesis of axis).

Type I

• fracture with <3 mm antero-posterior deviation
• no angular deviation

Type II

• fracture with >3 mm antero-posterior deviation
• significant angular deviation
• disruption of posterior longitudinal ligament

Type IIa

• the fracture line is horizontal/oblique (instead of vertical)
• significant angular deviation without anterior translation

Type III

• type I with bilateral facet joint dislocation

The Thoraco-Lumbar Injury Classification and Severity score (TLICS)

A classification system for thoracolumbar spine injuries, designed to assist in clinical management.

Unlike other classifications, the TLICS is an easy scoring system that depicts the features important in predicting spinal stability, future deformity, and progressive neurologic compromise. TLICS also facilitates appropriate treatment recommendations.

Clark West, Stefan Roosendaal, Joost Bot and Frank Smithuis.  TLICS Classification of fractures: Thoraco-Lumbar Injury Classification and Severity score. 2015

The information below is contained in papers found in the literature search carried out to inform this clinical decision making tool.

The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis and presently CT is mandatory for an accurate classification.

Columns

Denis divided the vertebral column into 3 vertical parallel columns based on biomechanical studies related to stability following traumatic injury. Instability occurs when injuries affect 2 contiguous columns (i.e. anterior and middle column or middle and posterior column). Obvious a 3 column injury is unstable.

The three columns are:

Anterior column

• anterior longitudinal ligament (ALL)
• anterior two-thirds of the vertebral body
• anterior two-thirds of the intervertebral disc (annulus fibrosus)

Middle column

• posterior one-third of the vertebral body
• posterior one-third of the intervertebral disc (annulus fibrosus)
• posterior longitudinal ligament (PLL)

Posterior column

• everything posterior to the PLL
• pedicles
• facet joints and articular processes
• ligamentum flavum
• neural arch and interconnecting ligaments

Guidelines

National Institute for Health and Care Excellence (NICE).  Spinal Injury: assessment and initial management. 2016.