Instability of spinal fractures - Therapeutic relevance and differing classifications

Purpose: To investigate if the assessment of spinal fracture stability according to the Magerl classification permits a better therapy decision than using the Denis 3-column model. Material and Methods: The X-ray and CT images of 99 consecutive patients treated for thoracolumbar spine fractures were analysed and the fractures were classified according to the above mentioned classifications. Using the 3-column model, the involvement of two or more columns was considered as unstable, whereas the fracture types A3.2, A3.3, B and C of the Magerl classification were defined as unstable. The stability evaluation was compared with the therapy decision and outcome. Results: According to the 3-column model, 23 of 53 fractures which were classified as unstable were operated. Only five of the 30 conservatively treated unstable fractures showed a reduced healing process. The 46 stable fractures were treated conservatively with good results. Using the Magerl classification, 21 of the 28 unstable fractures were operated and 4 of the remaining 7 cases showed a reduced healing process. Of the 71 stable fractures only 2 were operated and in one patient minimal neurological symptoms occurred. Conclusion: The Magerl classification enables a more exact definition of stable and unstable spinal fractures.