J Korean Soc Spine Surg.  2004 Jun;11(2):113-120. 10.4184/jkss.2004.11.2.113.

Distribution and Patterns of Posterior Column Injury in Flexion-Distraction Injuries of Thoracolumbar Spine

• Kim YM
• Kim DS
• Choi ES
• Shon HC
• Park KJ
• Jeong KI

• KMID: 2097818
• DOI: http://doi.org/10.4184/jkss.2004.11.2.113

Abstract

STUDY DESIGN: A retrospective analysis of the distribution and patterns of posterior column injury in flexion-distraction injuries of the thoracolumbar spine.
OBJECTIVES
To recognize the various types of posterior column injury in terms of the path of the distraction force in flexion-dis-traction injuries of the thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: As posterior column injuries are associated with instability of the spine, many authors have described and classified posterior column injuries. However, there are no descriptions or classifications in terms of the path of the distraction force in the literature. MATERIALS AND METHOD: The preoperative plain X-rays, axial CT, MRI (in 5 patients) and operation records of 34 patients were reviewed in relation to the patterns of posterior column injury.
RESULTS
Posterior column injuries can be classified into two main types. In Type I(30/34), the distraction failure started from the spinous process one level above the fractured body (Type IA) or the posterior ligament complex between the spinous processes of the fractured and the level above (Type IB). In Type II(4/34), the distraction failure started from the spinous process of the fractured vertebra and from the interspinous ligament between the fractured level and the level below.
CONCLUSIONS
Posterior column injuries can be described according to their starting point and the extent of the distraction force. Of these, Type IB was the most common. Using this classification, the injury of the posterior column in injuries of the thora-columbar spine fracture can be predicted.

Keyword

Flexion-distraction injury; Posterior column injury; Distraction force; Distribution and patterns

MeSH Terms

Classification
Humans
Ligaments
Magnetic Resonance Imaging
Retrospective Studies
Spine*

Figure

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  Fig. 1. Classification of posterior column injury according to the path of distraction force TypeⅠⅠ A: Distraction failure started from the spinous process of one level above. ⅠB : Distraction failure started from the posterior ligament complex between the spinous processes of fractured and one level above. TypeⅡⅡ A : Distraction failure started from the spinous process of the fracture vertebra. ⅡB : Distraction failure started from the posterior ligament complex between the spinous processes of the fractured and one level below.

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  Fig. 2. An example of Type Ⅰ A-2 T-L spine lateral X-ray shows wedge compression of L1 body and spinous process fracture of T12(arrow).

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  Fig. 3. An example of Type Ⅰ B-3 T-L lateral X-ray shows severe wedge compression of T11 and widened interspinous space between T10 and T11.

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  Fig. 4. An example of Type Ⅱ A T-L spine lateral X-ray shows wedge compression of L1 body and horizontal fracture of spinous process of the fractured vertebra(arrow).

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  Fig. 5. (A) An example of Type Ⅱ B T-L lateral X-ray shows wedge compression of L1 body and minimal widening of interspinous space between L1 and L2(arrow).(B) Operative finding shows disruption of posterior ligament complex between L1 and L2.

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