Combination of the AO-Magerl and load-sharing classifications for the management of thoracolumbar burst fractures.
The AO-Magerl classification is widely accepted for the appropriate management of patients with thoracolumbar burst fractures; however, it fails to assess the ability of the injured spine to withstand compressive loading and cannot predict instrumentation failure after short-segment posterior fixation. The load-sharing classification depends on the degree of comminution and apposition of bony fragments.We retrospectively classified according to both classifications 100 consecutive patients with 1-level thoracolumbar burst fractures treated nonoperatively or operatively within a 7-year period. Sixty neurologically intact patients (60%) were treated nonoperatively, 15 (15%) had short posterior instrumentation, 15 (15%) had short anterior instrumentation, and 10 (10%) had combined short posterior instrumentation and anterior strut grafting. Twenty-five of the 40 (60%) surgically treated patients had neurological impairment on admission. Clinical outcome was assessed using a pain and working ability scale. Mean follow-up was 52 months (range, 24-70 months). Function was satisfactory in 55 (92%) nonoperatively treated patients and in 33 (83%) surgically treated patients. Neurological improvement by American Spinal Injury Association (ASIA) grade was observed in patients with incomplete paraplegia (70% of neurologically impaired patients) who were treated operatively.The combination of AO-Magerl and load-sharing classifications provides for accurate selection of treatment, surgical approach, and length of instrumentation, and can guide the decision for additional anterior surgery.
Katonis
Pavlos
P
Department of Orthopedics & Traumatology, University of Crete Medical School, Heraklion, Crete, Greece. katonis@hol.gr
Pasku
Dritan
D
Alpantaki
Kalliopi
K
Mavrogenis
Andreas F
AF
Korres
Demetrios S
DS
Sapkas
George S
GS
Papagelopoulos
Panayiotis J
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D010808:Physical Examination / Q000379:methods* / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D020127:Recovery of Function; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult