Classification of spinal injuries based on the essential traumatic spinal mechanisms

Study design: A biomechanical unitary classification of spinal injuries is proposed. Objective: To present an evaluation of spinal injuries based on the essential traumatic spinal mechanisms: axial deformation, torsion, translation and combined mechanisms in connection with the concept of the stabilizing axial spinal pillar. Setting: Hospital 'Sf. Treime', Iasi, Romania. Methods: The essential mechanisms of spinal injuries are considered: ( 1) axial deformation with ( a) compression ( centric or eccentric), most often eccentric, including compression in flexion or extension; (b) spinal elongation with distraction as centric elongation, but frequently axial eccentric elongation and a flexion or extension injury; ( 2) torsion or axial spinal rotation, ( 3) segmental translation, with a shearing version for the double translation and ( 4) combined mechanisms - the most frequent situation. Over 300 patients with spinal injuries were analysed and the spinal instability was determined using the criteria of clinical instability. The cases of spinal instability were studied in connection with the types of lesion of the central axial spinal pillar. Results: All cases with lesions of the central axial spinal pillar had traumatic spinal instability. The spinal instability was absent in cases of isolated lesions of the anterior or posterior secondary pillar. The X-ray and spinal CT analysis of the traumatic spinal lesions showed the types of lesions and specified the mechanisms of spinal injuries. The combined mechanisms were responsible for the majority of the spinal injuries. Conclusions: Spinal instability occurs because of the lesion of the central axial spinal pillar The types of lesions of the central spinal pillar and of the secondary spinal pillars are determined by the essential traumatic spinal mechanisms: axial deformation ( with compression or elongation), axial rotation, translation and most frequently the above combined mechanisms.