{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T22:07:33Z","timestamp":1786658853548,"version":"build-2736575974"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T00:00:00Z","timestamp":1651190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Although they represent a significant chapter of traumatic pathology with a deep medical and social impact, thoracolumbar fractures have proven to be elusive in terms of a definitive classification. The ever-changing concept of the stability of a thoracolumbar injury (from Holdsworth\u2019s two-column concept to Denis\u2019 three-column theory), the meaningful integration of neurological deficit, and a reliable clinical usability have made reaching a universally accepted and reproductible classification almost impossible. The advent of sophisticated imaging techniques and an improved understanding of spine biomechanics led to the development of several classification systems. Each successive system has contributed significantly to the understanding of physiopathological mechanisms and better treatment management. Magerl et al. developed a comprehensive classification system based on progressive morphological damage determined by the following three fundamental forces: compression, distraction, and axial torque. Vaccaro et al. devised the thoracolumbar injury severity score based on the following three independent variables: the morphology of the injury, posterior ligamentous complex (PLC) integrity, and neurological status at the time of injury. However, there are limitations to the classification system, especially when magnetic resonance imaging yields an uncertain status of PLC. The authors review the various classification systems insisting on their practical relevance and caveats and illustrate the advantages and disadvantages of the most widely used systems with relevant cases from their practice.<\/jats:p>","DOI":"10.3390\/jcm11092498","type":"journal-article","created":{"date-parts":[[2022,4,30]],"date-time":"2022-04-30T05:44:07Z","timestamp":1651297447000},"page":"2498","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Analysis of the Classification Systems for Thoracolumbar Fractures in Adults and Their Evolution and Impact on Clinical Management"],"prefix":"10.3390","volume":"11","author":[{"given":"Bogdan","family":"Costachescu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, \u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Neurosurgery, \u201cProf. Dr. N. Oblu\u201d Clinical Emergency Hospital, 700309 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cezar Eugen","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u201cProf. Dr. N. Oblu\u201d Clinical Emergency Hospital, 700309 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-4083","authenticated-orcid":false,"given":"Bogdan Florin","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u201cGr. T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Department of Neurosurgery, \u201cProf. Dr. N. Oblu\u201d Clinical Emergency Hospital, 700309 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"key":"ref_1","first-page":"40","article-title":"Epidemiology of acute thoracolumbar fractures of youngadults in Hong Kong","volume":"5","author":"Om","year":"2001","journal-title":"Hong Kong J. Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"667","DOI":"10.14245\/ns.2142206.253","article-title":"Surgical Techniques for Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations","volume":"18","author":"Sharif","year":"2021","journal-title":"Neurospine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/00007632-199602150-00016","article-title":"Epidemiology of incident spinal fracture in a complete population","volume":"21","author":"Hu","year":"1996","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1080\/10790268.2018.1455018","article-title":"Epidemiological profile of thoracolumbar fracture (TLF) over a period of 10 years in Tianjin, China","volume":"42","author":"Li","year":"2019","journal-title":"J. Spinal Cord. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"704","DOI":"10.14245\/ns.2142418.209","article-title":"Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations","volume":"18","author":"Zileli","year":"2021","journal-title":"Neurospine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.injury.2008.06.040","article-title":"Epidemiology of traumatic spine fractures","volume":"40","author":"Leucht","year":"2009","journal-title":"Injury"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3171\/2012.8.SPINE111003","article-title":"Epidemiology of traumatic spinal fractures: Experience from medical university-affiliated hospitals in Chongqing, China, 2001\u20132010","volume":"17","author":"Wang","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"388","DOI":"10.21037\/jss.2018.06.07","article-title":"The impact of urgent intervention on the neurologic recovery in patients with thoracolumbar fractures","volume":"4","author":"Hidalgo","year":"2018","journal-title":"J. Spine Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"364","DOI":"10.5435\/00124635-200209000-00008","article-title":"Classifications of thoracic and lumbar fractures: Rationale and supporting data","volume":"10","author":"Mirza","year":"2002","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1007\/s00586-010-1415-9","article-title":"What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications","volume":"19","author":"Hanson","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_11","unstructured":"Boehler, L. (1930). Die Techniek der Knochenbruchbehandlung Im Grieden und Im Kriege, Verlag von Wilheim Maudrich."},{"key":"ref_12","unstructured":"Bohler, L. (1956). The Treatment of Fractures, Grune & Stratton. [5th ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.spinee.2009.04.003","article-title":"The evolution of thoracolumbar injury classification systems","volume":"9","author":"Sethi","year":"2009","journal-title":"Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"534","DOI":"10.3171\/2012.3.SPINE11570","article-title":"Does the Load-Sharing Classification Predict Ligamentous Injury, Neurological Injury, and the Need for Surgery in Patients with Thoracolumbar Burst Fractures?","volume":"16","author":"Radcliff","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s00586-014-3711-2","article-title":"How to use the load-sharing classification of spine fractures?","volume":"24","author":"Wang","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1177\/2192568219856581","article-title":"The Predictive Value of the Load Sharing Classification Concerning Sagittal Collapse and Posterior Instrumentation Failure: A Systematic Literature Review","volume":"10","author":"Stam","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1302\/0301-620X.45B1.6","article-title":"Fractures, dislocations, and fractures-dislocations of the spine","volume":"45B","author":"Holdsworth","year":"1963","journal-title":"J. Bone Joint Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1097\/00007632-199408000-00014","article-title":"The Load Sharing Classification of Spine Fractures","volume":"19","author":"McCormack","year":"1994","journal-title":"Spine"},{"key":"ref_19","first-page":"1447","article-title":"Osteosynthese du rachis dorsal, lombaire et lombosacree par plaque metalliques vissees dans les pedicles vertebraux et les apophyses articulaires","volume":"78","author":"Demeulenaere","year":"1970","journal-title":"Presse Med."},{"key":"ref_20","first-page":"2","article-title":"Osteosynthesis of thoracolumbar spine fractures with metal plates screwed through the vertebral pedicles","volume":"15","author":"Saillant","year":"1976","journal-title":"Reconstr. Surg. Traumatol."},{"key":"ref_21","unstructured":"Roy-Camille, R., Saillant, G., and Bisserie, M. (1984, January 9). Surgical treatment of spinal metastatic tumors by posterior plating and laminectomy. Proceedings of the 51st Annual Meeting of the American Academy of Orthopaedic Surgeons, Atlanta, GA, USA."},{"key":"ref_22","unstructured":"Roy-Camille, R., Saillant, G., Lapresle, P., and Mazel, C. (1984, January 9). A secret in spine surgery: The pedicle. Proceedings of the 51st Annual Meeting of the American Academy of Orthopaedic Surgeons, Atlanta, GA, USA."},{"key":"ref_23","first-page":"7","article-title":"Internal fixation of the lumbar spine with pedicle screw plating","volume":"203","author":"Saillant","year":"1986","journal-title":"Clin. Orthop. Rel. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1097\/00007632-198311000-00003","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spine injuries","volume":"8","author":"Denis","year":"1983","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1080\/02688697.2020.1777256","article-title":"Thoracolumbar fracture classification: Evolution, merits, demerits, updates, and concept of stability","volume":"35","author":"Prajapati","year":"2021","journal-title":"Br. J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/BF02221591","article-title":"A comprehensive classification of thoracic and lumbar injuries","volume":"3","author":"Magerl","year":"1994","journal-title":"Eur. Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.rbo.2017.07.010","article-title":"Intraobserver and interobserver reproducibility of the old and new classifications of toracolombar fractures","volume":"53","author":"Lopes","year":"2018","journal-title":"Rev. Bras. Ortop."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1097\/01.brs.0000182986.43345.cb","article-title":"A new classification of thoracolumbar injuries: The importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status","volume":"30","author":"Vaccaro","year":"2005","journal-title":"Spine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1007\/s00586-016-4663-5","article-title":"Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: Results of a multicentre study","volume":"26","author":"Kaul","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4184\/asj.2010.4.2.109","article-title":"Reliability and validity of thoracolumbar injury classification and severity score (TLICS)","volume":"4","author":"Kim","year":"2010","journal-title":"Asian Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1007\/s00586-013-2738-0","article-title":"AO spine injury classification system: A revision proposal for the thoracic and lumbar spine","volume":"22","author":"Reinhold","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1097\/BRS.0b013e3182a8a381","article-title":"AOSpine thoracolumbar spine injury classification system: Fracture description, neurological status, and key modifiers","volume":"38","author":"Vaccaro","year":"2013","journal-title":"Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1007\/s00586-015-3765-9","article-title":"Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naive spinal surgeons","volume":"25","author":"Kepler","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s00586-015-3982-2","article-title":"The surgical algorithm for the AOSpine thoracolumbar spine injury classification system","volume":"25","author":"Vaccaro","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1007\/s00586-014-3312-0","article-title":"Progressive kyphotic deformity in comminuted burst fractures treated non-operatively: The Achilles tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS)","volume":"23","author":"Mattei","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s00113-008-1503-z","article-title":"Type B injuries of the thoracolumbar spine: Misinterpretations of the integrity of the posterior ligament complex using radiologic diagnostics","volume":"111","author":"Schnake","year":"2008","journal-title":"Unfallchirurg"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"19494","DOI":"10.1038\/s41598-020-76473-9","article-title":"Clinical relevance and validity of TLICS systemfor thoracolumbar spine injury","volume":"10","author":"Park","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14444\/5001","article-title":"A Comparison of Three Different Methods of Fixation in the Management of Thoracolumbar Fractures","volume":"12","author":"Panteliadis","year":"2018","journal-title":"Int. J. Spine Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2174\/1874325001610010135","article-title":"Radiological Prediction of Posttraumatic Kyphosis after Thoracolumbar Fracture","volume":"10","author":"Curfs","year":"2016","journal-title":"Open Orthop. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1097\/BRS.0000000000001253","article-title":"Nonoperative Management in Neurologically Intact Thoracolumbar Burst Fractures: Clinical and Radiographic Outcomes","volume":"41","author":"Hitchon","year":"2016","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Tan, T., Huang, M.S., Rutges, J., Marion, T.E., Fitzgerald, M., Hunn, M.K., and Tee, J. (2021). Rate and Predictors of Failure in the Conservative Management of Stable Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis. Glob. Spine J., 1\u201313.","DOI":"10.1177\/21925682211031207"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"681","DOI":"10.14245\/ns.2142340.170","article-title":"Kyphosis After Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations","volume":"18","author":"Yaman","year":"2021","journal-title":"Neurospine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"713","DOI":"10.14245\/ns.2142390.195","article-title":"Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations","volume":"18","author":"Peev","year":"2021","journal-title":"Neurospine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2498\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:04:04Z","timestamp":1760137444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,29]]},"references-count":43,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["jcm11092498"],"URL":"https:\/\/doi.org\/10.3390\/jcm11092498","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,29]]}}}