Spine scoring systems Flashcards
ASIA score
mJOA score
modified Japanese Orthopaedic Association score
What is mJOA measuring?
What can mJOA be used for?
Its used in international guidelines for management of DCM (degenerative cervical myelopathy). To grade the severity and advice on best treatment strategy.
What is the Weinstein, Boriani, Biagimi scoring system?
Classification of spinal tumors.
Location described as 12 radiating regions clockwise using the spinal process as 0 and (patients) left side as no 1-6.
Then A-E describes concentric layers where D= epidural and E= intradural.
What is Lavine classification for?
It is to establish the amount and displacement of a hangman fracture to determine stability and treatment.
Describe Lavine classification system
Type1-
minimally displaced (less or = 3mm antero-posterior translation)
* no angulation
* due to axial load and hyperextension
* stable
—-Collar immobilisation–
Type II-
* DIsplaced more than 3mm anterio-posteriorly.
* angulation LESS than 10 degree
* vertical line frx.
* C2/3 disc and PLL are DISRUPTED
* obs! - distractive flexion or compressive hyperextension
**Unstable frx*
—-Halo or surgery—-
Type IIa -
As type 1 but WITH MARKED ANGULATION.
* angulation more than 10degrees.
* horizontal or oblique frx line
* ALL INTACT
Unstable frx
—Compression Halo WITHOUT traction—
Type IIa-
Type III - rare. bilateral facet joint dislocation. Distractive flexion mechanism. –always surgery–
What type of frx are classified by Anderson and D Alonzo?
Fractures of the odontoid process of C2.
What is type I frx according to Anderson and D Alonzo?
*Rare
*Frx of the upper part of the odontoid peg (generally oblique frx)
*Above the level of the transverse band of the cruciform ligament.
* Usually considered STABLE
What is type II frx according to Anderson and D Alonzo?
- MOST COMMON
- transverse course at THE BASE of the odontoid.
- BELOW the level of the transverse band of the cruciform ligament
- UNSTABLE
- HIGH RISK OF NON_UNION
What is type IIa frx according to Anderson and D Alonzo?
- Type II frx w comminution at the odontoid base.
- SIGN INCREASE of NONUNION when treated non-operatively
(5-10% of type II)
What is type III frx according to Anderson and D Alonzo?
- Through the odontoid and into the lateral masses of C2!
- Relatively stable if not extensively displaced.
- Best prognosis of healing due to the large frx surface.
What is the McAfee classification?
One of a number of thoracolumbar spinal fracture classification systems. Based on three column concept.
What is the AO classification of thoracolumbar injuries?
primarily descriptive rather than aiming to determine treatment
For CT.
Three separate components to every injury are coded. Which are they?
- injury morphology
- neurological status
- indeterminate status of ligamentous intergrity or presence of comorbid conditions. -modifiers
What are the three morphologies described in AO?
A - compression injuries
B- distraction injuries
C- displacement/translational injuries.
If multiple injuries are present at the same level, the primary coding is the more severe injury.
Type A -compression injuries involve the vertebral body. Except A0. What are the different types?
A0 - no fracture or clinically insignificant fracture of the spinous or transverse processes
A1 - wedge compression or impaction fracture, which involves a single endplate of the vertebral body without involvement of the posterior vertebral wall
A2 - split or pincer type fracture, which involves both endplates without the involvement of the posterior wall
A3 - incomplete burst fracture, which involves a single endplate along with the posterior vertebral wall
A4 - complete burst fracture, which involves both endplates along with the posterior vertebral wall; split fractures that involve the posterior vertebral wall are also included
Type B AO injuries - Which are they?
Type B injuries involve either the anterior or posterior tension band and are often combined with type A vertebral body fractures.
B1 - Chance fracture or pure transosseous tension band disruption, which involves a single vertebra with fracture through the pedicles and out the pars interarticularis or spinous process
B2 - osseoligamentous posterior tension band disruption, which involves a motion segment with disruption of the posterior ligamentous complex with or without involving the bony posterior elements
B3 - hyperextension injuries, which disrupt the anterior tension band by tearing the anterior longitudinal ligament and extending either through the intervertebral disc or vertebral body; the injury may extend into the posterior tension band but an at least partially intact posterior hinge prevents complete displacement
what is the anterior tension band?
It includes the anterior longitudianal ligament.
What is the posterior tension band?
a combination of osseous and ligamentous structures, including the supraspinous ligaments, interspinous ligaments, articular facet capsules, and ligamenta flava
Another name for “Chance fracture”?
Seatbelt fracture
What is a chance fracture?
A flexion-distraction type of injury that extend to involve all three spinal columns.
Are chance fractures dangerous?
They are unstable injuries and have ahigh association to intra-abdominal injuries.
50% of chance frx are found in the same spot. Where?
in the thoracolumbar junction.
Intraabdoorgans?minal associated injuries to chance frx are especially common in children. How common? and what are the most common injured
50%!
pancreas and duodenum.
HOw does a Chance frx look on CT?
Anterior wedge fracture of the vertebral body with a horizontal fracture through posterior elements or distraction of facet joints and spinous processes.
What are the treatmentoptions for chance frx?
Non-surgical management may be suitable for patients with no neurological defects and stable posterior elements 5. It should be noted that patients managed non-operatively need long term follow-up to ensure they do not develop any kyphotic deformity.
Patients with any neurological deficit or unstable fracture patterns (damage to the posterior ligaments) will need surgical fixation to decompress the spinal cord and stabilize the fracture 5. If immobilization is impractical (large body habitus) or the patient has polytrauma, surgical management may also be indicated.
Type C -displacement/translational injuries.
What are the different types?
Type C injuries involve displacement in any direction. No subtypes are present as there are numerous possibilities of dislocating fractures. However, they should be specified along with relevant vertebral body (A-type) or tension band (B-type) injuries to better describe the morphology.
Distraction (B-type) fractures with clear and complete disruption of both anterior and posterior vertebral elements/tension bands should be described as a type C injury with secondary B descriptor even if there is not displacement at the time of imaging 1.
Neurological signs are described as N0-N4. And Nx - cannot be assessed.
What are the definitons?
N0: no focal neurological signs present
N1: a history of transient neurological deficit
N2: current signs or symptoms of radiculopathy
N3: an incomplete spinal cord or cauda equina injury
N4: complete spinal cord injury (complete absence of motor and sensory function; ASIA A)
Describe the two types of modifiers in AO classification
M1: the presence of tension band injury is indeterminate (whether or not MRI was performed); applies to injuries that seem stable from a bony standpoint (type A) but the possibility of ligamentous insufficiency (type B) remains, which would guide consideration of operative stabilization
M2: the presence of co-morbid conditions such as ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, osteopenia, osteoporosis, overlying burns, etc.
Scoring
The thoracolumbar AOSpine injury score (TL AOSIS) was devised and validated to guide surgical treatment 5. The injury categories correspond to points.
Describe the points.
Injury type:
A0: 0 points
A1: 1 point
A2: 2 points
A3: 3 points
A4: 5 points
B1: 5 points
B2: 6 points
B3: 7 points
C: 8 points
Neurologic status:
N0: 0 points
N1: 1 point
N2: 2 points
N3: 4 points
N4: 4 points
NX: 3 points
Patient-specific modifiers:
M1: 1 point
M2: 0 points
The points from the three categories are added together. Based on a survey of practitioners, the following treatment algorithm was suggested:
0-3 points: conservative treatment
4-5 points: operative or non-operative treatment
> 5 points: surgical intervention
In general, are anterior column injuries stable or unstable?
stable
In general, are middle column injuries stable or unstable?
unstable
In general, are posterior column injuries stable or unstable?
Not acutely unstable but chronic instability with kyphotic instability may develop. Especially in children.
