Classifications of Thoracic and Lumbar Fractures: Rationale and Supporting Data

Classification systems are generalizations that attempt to identify common attributes within a group to predict behavior or outcome without sacrificing too much detail. Because of the inherent variability of fractures, classifying them can be difficult. To properly apply any of the commonly cited classification schemes for thoracic and lumbar fractures, one must not only know the injury categories described in the original studies but also be familiar with the rationale for developing the classification. Many original reports describing common thoracic and lumbar injury classifications lack a rigorous scientific foundation. They were based largely on the insights of experienced surgeons and researchers. Although the ideal classification for thoracic and lumbar fractures does not exist, it would incorporate neurologic as well as structural factors. Standardization of terminology as related to treatment decisions and prognosis is key to an improved understanding of the clinical behavior of these injuries and identification of optimal treatment options.