Thoracic and lumbar spine trauma classification systems fail to predict post-traumatic kyphotic deformity

Document Type

Journal Article

Publication Date



North American Spine Society journal






AO classification spine trauma; AO, Arbeitsgemeinschaft für Osteosynthesefragen; Anterior longitudinal ligament; Denis classification; Load-sharing classification; MRI of spine trauma; PLC, posterior ligamentous complex, anterior longitudinal ligament-ALL; PLL, posterior longitudinal ligament; Post-traumatic kyphosis; Posterior ligamentous complex (PLC); TLICS classification; TLICS, Thoraco-Lumbar injury Classification and severity scale; Thoracolumbar spine trauma


Background: Post-traumatic kyphosis of the thoracic and lumbar spine can lead to pain and decreased function. MRI has been advocated to assess ligament integrity and risk of kyphosis. Methods: All thoracic and lumbar spine MRI performed for evaluation of trauma over a 3-year period at a single institution were reviewed. Patients were included if there was an MRI showing a vertebral body fracture and follow-up radiographs. Two observers retrospectively reviewed all radiographs, CT and MRI scans, and classified injuries based on the Denis, TLICS, AO and load sharing classification systems. Change in kyphosis between injury and follow-up studies was measured. The initial radiology reports made at time of patient injury were compared to the retrospective interpretations. Results: There were 67 separate injuries in 62 patients. Kyphosis measuring ≥ 10° developed despite an intact PLC in 6/14 nonoperative cases, and 3/7 surgically treated cases; when PLC was partially injured, it developed in 6/10 cases (8 treated nonoperatively, 2 treated operatively. Thirty injuries had complete disruption of PLC by MRI, 24 treated with fusion. Kyphosis ≥ 10° developed in 3/6 treated nonoperatively, and 8/24 treated with fusion. Development of kyphosis was independent of degree of vertebral body comminution. It developed equally in patients with Grade 2 and Grade 3 Denis injuries. It developed in patients with intact PLC when multiple vertebrae were involved and/or there was compressive injury to anterior longitudinal ligament (ALL). There was high interobserver variability in assessment of severity of ligamentous injury on MRI. Conclusions: Classification systems of thoracic and lumbar spine injury and integrity of the PLC failed to predict the risk of development of post-traumatic kyphotic deformity.