Thoracolumbar Spine Trauma: Pearls and Pitfalls of the Newer Classification Systems

E. Bonfante, A. Tenreiro, J. Choi, E. Supsupin, and R. Riascos and M. Hagiwara

View Article on Neurographics Website

Date of Activity Release: Apr. 1, 2018
Date of Activity Expiration: Apr. 1, 2021

Target Audience:
Intended for neuroradiologists and neuroradiology trainees with varying degrees of experience.

Learning Objective:
1) To be familiar with the two most commonly used classification systems used in guiding clinical and surgical treatment of thoracolumbar fractures, including the limitations of both; 2) describe the roles of multidetector CT and MR imaging in the evaluation of spinal trauma, specifically, the respective strength of these imaging modalities in the assessment of bony and soft tissue injuries; 3) understand anatomy and biomechanics of the spine relevant to trauma, particularly the concept of the functional spinal unit; and 4) empower radiologists to help improve patient outcomes by incorporating concepts from the two most recent classifications into their daily practice of spinal trauma imaging, with prompt communication to the clinical team.

Patients who endure blunt trauma are commonly affected by thoracic and lumbar spinal fractures, which comprise approximately 50% of all vertebral fractures. Neurologic injury to the spinal cord occurs in 19% to 50% of these patients. Numerous classification systems have been developed to guide clinical and surgical treatment of thoracolumbar fractures. Currently, the two most commonly used classification systems in thoracolumbar spine trauma are the Arbeitsgemeinschaft fu¨r Osteosynthesefragen Spine Thoracolumbar Spine injury Classification System and the Thoracolumbar Injury Classification System. CT and MR imaging play complementary roles in the evaluation of spine injuries. The morphology of the injury is identified in the CT examinations, which also allows one to infer some of the soft-tissue injuries. MR imaging provides valuable information with regard to the soft tissues, including the ligamentous structures, the cord, and the extra-axial spaces. Unstable injuries evolve over time and represent a risk for developing or worsening of neurologic damage. Neuroradiologists should be aware of the clinical implications of using these classifications and how they can help improve patient outcome.

Commercial Support
No commercial support was received for this activity.

Credit Designation Statement

The American Society of Neuroradiology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Neuroradiology designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Physician Participation:
Each participant will review the corresponding Neurographics article located at Upon completion, each physician will complete and pass a post-test with a score of at least 80% to receive a CME certificate.

All individuals in control of content have disclosed the following relevant financial relationships. All of these relationships were treated as a conflict of interest, and have been resolved (C7 SCS 6.1-6.2, 6.5)

Authors have no relevant financial relationships.





Barton Branstetter 

Editor in Chief

None, N/A

Adam Flanders

Deputy Editor

Royalties, Lippincott Williams and Wilkins

Robert Quencer 

Consulting Editor

None, N/A

Mark Mullins

Associate Editor

Non-remunerative position, AUR6

Meng Law

Associate Editor

Stockholder, Clinical Imaging

Edward Escott

Associate Editor

Grant, Atherysys, Inc.; Royalties, Thieme Medical Publishers

Scott Faro

Associate Editor

None, N/A

Tina Young Poussaint

Associate Editor

None, N/A

Dheeraj Ghandi

Associate Editor

Grant, Arstasis, Axera Inc.; Consultant, Covidien, EV3

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