Thoracolumbar Burst Fracture: McCormack Load-sharing Classification

Filgueira, Ériko Gonçalves; Imoto, Aline Mizusaki; Silva, Helbert Eustáquio Cardoso da; Meves, Robert

doi:10.1097/brs.0000000000003826

Cited by 9 publications

(3 citation statements)

References 37 publications

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“… 11 However, the original McCormack study’s results were questioned due to the small number of cases (n = 28) and the use of outdated instrumentation techniques. 21 The original McCormack study relied on the amount of corrected kyphosis, i.e., the difference between postoperative and preoperative kyphosis, which can not be implemented in preoperative decision-making. 11 In 2018 De Lure F et al proposed the ‘‘vertebral body spread”“ to objectively to evaluate the percentage of vertebral body comminution and spreading of the fractured fragments.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Comminution and Posterior Ligamentous Complex Integrity on Treatment Decision Making in Thoracolumbar Burst Fractures Without Neurologic Deficit?

Aly,

Dandurand,

Dvorak

et al. 2024

Global Spine Journal

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Study Design A prospective study. Objective to evaluate the impact of vertebral body comminution and Posterior Ligamentous Complex (PLC) integrity on the treatment recommendations of thoracolumbar fractures among an expert panel of 22 spine surgeons. Methods A review of 183 prospectively collected thoracolumbar burst fracture computed tomography (CT) scans by an expert panel of 22 trauma spine surgeons to assess vertebral body comminution and PLC integrity. This study is a sub-study of a prospective observational study of thoracolumbar burst fractures (Spine TL A3/A4). Each expert was asked to grade the degree of comminution and certainty about the PLC disruption from 0 to 100, with 0 representing the intact vertebral body or intact PLC and 100 representing complete comminution or complete PLC disruption, respectively. Results ≥45% comminution had a 74% chance of having surgery recommended, while <25% comminution had an 86.3% chance of non-surgical treatment. A comminution from 25 to 45% had a 57% chance of non-surgical management. ≥55% PLC injury certainity had a 97% chance of having surgery, and ≥45-55% PLC injury certainty had a 65%. <20% PLC injury had a 64% chance of having non-operative treatment. A 20 to 45% PLC injury certainity had a 56% chance of non-surgical management. There was fair inter-rater agreement on the degree of comminution (ICC .57 [95% CI 0.52-.63]) and the PLC integrity (ICC .42 [95% CI 0.37-.48]). Conclusion The study concludes that vetebral comminution and PLC integrity are major dterminant in decision making of thoracolumbar fractures without neurological deficit. However, more objective, reliable, and accurate methods of assessment of these variables are warranted.

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Section: Discussionmentioning

confidence: 99%

The Influence of Comminution and Posterior Ligamentous Complex Integrity on Treatment Decision Making in Thoracolumbar Burst Fractures Without Neurologic Deficit?

Aly,

Dandurand,

Dvorak

et al. 2024

Global Spine Journal

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show abstract

“…This is further complicated by the fact that not all fractures are equivalent, and some are better suited for short-segment constructs, such as flexion-distraction injuries, mild burst fractures, or fracture/dislocation injuries [ 20 ]. The McCormick score is a useful tool, giving guidance as to which fractures require sole posterior fixation (a score <6 being the cutoff) [ 21 ]. Additional index screws can increase construct strength, but short-segment constructs are still generally inferior to long-segment constructs [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Advantages of Short-Segment Fusion in the Surgical Management of Thoracolumbar Traumatic Fractures: A Case Series and Review of the Literature

Mugge¹,

Dang²,

Awan³

et al. 2023

Cureus

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Introduction: Spine trauma is a common pathology that frequently requires neurosurgical intervention. Few studies have examined short-segment, 360-degree stabilization of traumatic thoracolumbar fractures. Methods: A retrospective review was completed of adult and pediatric patients who underwent surgical correction for thoracolumbar fractures between December 2011 and December 2021. Results: Forty patients met the inclusion criteria. The majority of patients presented with an American Spinal Injury Association (ASIA) score of D (n = 11) or E (n = 21). The most common level of injury was L1 (n = 20). The average length of stay was 11.7 days. Postoperatively, two patients had pulmonary emboli or deep venous thrombosis, and two had surgical site infections. Most patients were discharged to home (n = 21) or acute rehab (n = 14). The fusion rate at six months was 97.5%. Neurologically, all patients regained ambulation by >18 months follow-up. For the ASIA scale, most had a score of D (n = 4) or E (n = 32) at six months. The same trend was observed with the Frankel score, where most patients had either D (n = 5) or E (n = 31), improving to only two having a score of D at >18 months. Conclusions: Corpectomy followed by posterior fusion has a number of biomechanical benefits. This construct permits circumferential decompression, larger surface area for fusion, improved reconstitution of vertebral body height, reduced kyphosis, and an overall shorter segment. This results in fewer levels needing to be fused while enabling the greatest changes of successful fusion.

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“…For evaluating thoracolumbar vertebral fracture severity, we used the McCormack load-sharing classification. As previously reported, the McCormack load-sharing classification consisted of the scoring of three parameters, including comminution, apposition of fragments, and deformity correction, and was used for evaluating spinal anterior column injury and spinal instability [ 6 , 7 ]. Further, in the current study, scores were summed when patients had multiple thoracolumbar vertebral fractures.…”

Section: Methodsmentioning

confidence: 99%

The Relationship Between Falling Distance and Trauma Severity Among Fall Injury Survivors Who Were Transported to a Trauma Center

Muneshige¹,

Miyagi²,

Inoue³

et al. 2022

Cureus

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Introduction Falls from >6 meters have been shown to cause multiple traumas and serious injuries. However, especially among fall survivors who were transported to trauma centers, the relationship between falling distance and trauma severity remains unclear. This study aimed to investigate the relationship between falling distance and trauma severity among fall injury survivors who were transported to a trauma center and clarify the characteristics of trauma among survivors of falls from high places from an orthopedic surgeon’s perspective. Methods We retrospectively reviewed the medical records of 65 fall injury survivors who were transported to a trauma center for falling distance; whether the fall was a suicide attempt; abdominal, chest, and head trauma; the numbers of upper-limb, lower-limb, and spinal vertebral fractures; McCormack load-sharing classification score; unstable pelvic fracture; Frankel classification; injury severity score (ISS); and duration of intensive care unit (ICU) and hospital stay. We evaluated the correlations between falling distance and the other factors and compared all factors between those falling <6 meters and those falling >6 meters. Results Falling distance was weakly positively correlated with durations of ICU and hospital stay. The percentage of cases that were suicide attempts, the number of lower-limb fractures, the McCormack load-sharing classification score, and the durations of ICU and hospital stay were significantly higher among those falling from >6 meters than among those falling from <6 meters. Conversely, there were no significant differences in abdominal trauma, chest trauma, head trauma, number of upper-limb fractures, number of vertebral fractures, unstable pelvic fracture, or Frankel classification between the two groups. Conclusion The findings indicate that falling from a higher distance may increase lower-limb and vertebral fracture severity and may lead to longer ICU and hospital stays among fall injury survivors who are transported to trauma centers.

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Thoracolumbar Burst Fracture: McCormack Load-sharing Classification

Cited by 9 publications

References 37 publications

The Influence of Comminution and Posterior Ligamentous Complex Integrity on Treatment Decision Making in Thoracolumbar Burst Fractures Without Neurologic Deficit?

The Influence of Comminution and Posterior Ligamentous Complex Integrity on Treatment Decision Making in Thoracolumbar Burst Fractures Without Neurologic Deficit?

Advantages of Short-Segment Fusion in the Surgical Management of Thoracolumbar Traumatic Fractures: A Case Series and Review of the Literature

The Relationship Between Falling Distance and Trauma Severity Among Fall Injury Survivors Who Were Transported to a Trauma Center

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