A Clinical Study of Unstable Fractures and Fracture-Dislocations of the Thoracolumbar Spine - Comparision Between Holdsworth, Denis and McAfee Classification -

Kim, Yong Jin; Suh, Jung Tak; Park, Sang Ho; Yoo, Chong Il

Abstract

The thoracolumbar spine is relatively easily traumatized and result in serious complications such as neurologic impairment and instability, so its proper management is very important. Formerly the thoracolumbar spine injury was evaluated mainly by plain radiographs, and tomograms if indicated,but because computed tomography visualizes bone and soft tissues three-dimensionally, we tried to compare its value with that of plain radiographs in potentially unstable thoracolumbar injuries. From January 1984, we determined the stability of the potentially unstable thoracolumbar spine injury according to computed tomography finding and compared with plain radiography finding, and the following results were obtained. 1. By Holdsworth classification, it was difficult to determine the stability of the thoracolumbar spine injury. 2. In cases of compression fracture and burst fracture by Denis classification, it was necessary to determine the stability by computed tomography. 3. In cases of unstable burst fracture by McAfee classification, there was no direct relationship between the degree of canal occlusion and neurological deficit, but above 25% in conus medullaris lesion and above 50% in cauda equina lesion usually manifested neurological deficit. 4. In our cases, the neurological status of initial injury was important factor to determine the improvement rate.