Cervical, thoracolumbar, and sacral spine trauma classifications: past, present, and future

ABSTRACT

Objective

Traumatic spine injuries are a relatively common occurrence and are associated with functional impairment, loss of neurologic function, and spinal deformity. A number of spinal trauma classification systems have been developed with varying degrees of acceptance. This review provides a chronological overview of spinal trauma classification systems, with special consideration towards the benefits and pitfalls related to each. Cervical, thoracolumbar, and sacral trauma classification systems are discussed.

Methods

A review of the literature was performed. Published articles that reported on bony spinal trauma classification systems were examined. No year exemptions were identified. The reference lists of all selected articles were screened for additional studies. Article inclusion and exclusion criteria were defined a priori.

Results

A total of 20 classification systems were identified from years 1938–2017. Of these 20 classification systems, 6 were cervical, 11 were thoracolumbar and 3 were sacral. The modernization of bony spinal trauma classification has been characterized by the development of weighted scales that include injury morphology, integrity of associated ligamentous structures and neurologic status.

Conclusion

For widespread acceptance and adoption in the clinical setting, future spinal trauma scoring classification will need to remain simple, highly reproducible, and impart information with regard to clinical decision-making and prognosis that may be effectively communicated across each medical specialty involved in the care of these patients.

KEYWORDS:

• Spine
• trauma
• classification
• cervical
• thoracic
• lumbar

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

No external funding was provided.

Notes on contributors

Christina Gerges

Christina Gerges is a UCLA alumna and fourth year medical student at Case Western Reserve University School of Medicine. She will be applying for neurological surgery residency in 2020. Her areas of interest are continuously evolving, but currently include neurotrauma, spine surgery, and social determinants of healthcare outcomes.

Alankrita Raghavan

Alankrita Raghavan is a PGY-1 in neurosurgery at Duke. She received her MD at Case Western Reserve University School of Medicine. She is interested in global neurosurgery, clinical outcomes research, and neurosurgical oncology.

James Wright

James Wright completed residency in neurological surgery at University Hospitals Cleveland Medical Center/Case Western Reserve University in Cleveland, Ohio and is currently a fellow in complex spine surgery at Cleveland Clinic. During residency in Cleveland he was chosen as a Congress of Neurological Surgeons (CNS) Leadership Fellow, Council of State Neurosurgical Societies (CSNS) Socioeconomic Fellow, and was appointed to the Young Neurosurgeons Committee. His primary interests are neurocritical care, brain and spine trauma, and spinal oncology. He will be pursuing a career in academic neurosurgery in Portland, Oregon following graduation from fellowship.

Berje Shammassian

Berje Shammassian is the current neurosurgery chief resident at University Hospitals Cleveland Medical Center / Case Western Reserve University in Cleveland, Ohio, where he also completed an enfolded neurocritical care fellowship. He received his undergraduate and medical degrees from the University of Maryland and his MPH from Johns Hopkins University. He will go on to continue his training in critical care upon completion of his residency.

Christina Huang Wright

Christina Huang Wright graduated neurosurgery residency in 2020 from University Hospitals Cleveland Medical Center/ Case Western Reserve University in Cleveland, Ohio and will complete a complex spine fellowship at Cleveland Clinic Foundation from 2020-2021. She has an interest in patient safety, quality, and outcomes research in both spine and general neurosurgery.

Timothy Moore

Timothy Moore is a spine surgeon and professor of Orthopeadic and Neurosurgery at Case Western Reserve Univeristy School of Medicine. He received his undergraduate degree from Capital University in Columbus, Ohio and his medical degree from Wright State University School of Medicine in Dayton, Ohio. He completed orthopaedic surgery residency at the Cleveland Clinic Foundation and continued his training as a spine surgery fellow at the University of Wisconsin in Madison, Wisconsin. His specialities are spine trauma and cervical degenerative diseases.