Is open anterior advantageous to posterior decompression and reconstruction in fresh A(3) to C(3)/AO type thoracolumbar junction fractures? A systematic review.

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Abstract

[Indexed for MEDLINE] 5. Clin Radiol. 2021 Dec;76(12):941.e1-941.e10. doi: 10.1016/j.crad.2021.09.006. Epub 2021 Sep 25. Subaxial spine trauma: radiological approach and practical implications. Masson de Almeida Prado R(1), Masson de Almeida Prado JL(2), Ueta RHS(3), Guimarães JB(4), Yamada AF(5). Author information: (1)Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil; United Health Group Brasil (UHG), São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil. (2)Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil; United Health Group Brasil (UHG), São Paulo, Brazil. Electronic address: renatomasson@gmail.com. (3)Department of Orthopedics and Traumatology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. (4)Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil. (5)Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil; Department of Radiology, Hospital Do Coração - HCor and Teleimagem, Rua Desembargador Eliseu Guilherme, 53, 7th Floor, 04004-030, São Paulo, Brazil. The cervical spine is part of the axial skeleton and is responsible for protecting vital structures, such as the spinal cord and the vertebral arteries and veins. Traumatic injury to the cervical spine occurs in approximately 3% of blunt trauma injuries, and approximately 80% are below the level of C2. The AO Spine society divides the spine into four segments: the upper cervical spine (C0-C2), subaxial spine (C3-C7), thoracolumbar spine, and sacral spine. Various classifications have been proposed for the subaxial segment since that of Allen and Ferguson in 1982; however, none is universally accepted, and treatment remains controversial. The complex anatomy and biomechanics of the subaxial spine and the lack of a widely accepted classification system make these injuries difficult to evaluate on imaging. The Subaxial Injury Classification System (SLIC) uses fracture morphology, the integrity of discoligamentous complex, and neurological status to score the patient and determine between operative and non-operative management; however, other factors may influence management, such as time for immobilisation, osteoporosis, surgeon's experience, and hospital circumstances. SLIC classifies fracture morphology in a crescent order of severity based on Allen and Ferguson's classification. Compression fractures are the simpler ones, while both distraction injuries and translation/rotation are severe injuries, which are always associated with some degree of discoligamentous complex (DLC) injury. This article will review the indications for imaging, the basis of the SLIC classification, the different types of fracture morphology, evaluation of the DLC, and other features important in decision making in subaxial spine trauma. Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. DOI: 10.1016/j.crad.2021.09.006