Die AOSpine-Klassifikation thorakolumbaler Wirbelsäulenverletzungen

 

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Zusammenfassung

Die optimale Behandlung von Verletzungen des thorakolumbalen Übergangs basiert auf einem guten Verständnis der Wirbelsäulenverletzung unter Berücksichtigung der Frakturmorphologie, der ligamentären Integrität und der neurologischen Ausfallsymptomatik. Ein Klassifikationssystem hilft dabei, diese Analyse zu strukturieren und sollte einen Leitfaden für die Behandlung offerieren. Die gebräuchlichen Klassifikationssysteme, wie z. B. die Magerl-Klassifikation oder die TLICS-Klassifikation sind entweder sehr komplex, berücksichtigen nicht den neurologischen Status oder vereinfachen die Frakturmorphologie als Indikator der Instabilität zu sehr. Die „AOSpine Classification Group“ hat daher eine neue Klassifikation entwickelt, die sowohl auf der Magerl- als auch auf der TLICS-Klassifikation basiert, und die Schwächen dieser beiden Klassifikationen überwinden soll. Dabei bietet sie auch eine Quantifizierung des Verletzungsschweregrads und lässt damit eine Vergleichbarkeit von Wirbelsäulenverletzungen zu. Wie in der bisherigen AO-Klassifikation unterscheidet sie dabei 3 Grundtypen der Verletzung: Typ-A-Verletzungen sind knöcherne Kompressionsverletzungen der Wirbelsäule. Typ-B-Verletzungen zeigen Zerreißungen entweder der hinteren oder der vorderen Zuggurtung und Typ-C-Verletzungen sind translatorisch instabile Verletzungen. Nur Typ-A- und Typ-B-Verletzungen werden in weitere Untergruppen unterteilt. Eine begleitende neurologische Läsion wird vom transienten neurologischen Defizit bis zur kompletten Querschnittslähmung in 5 Schweregrade unterteilt. Weitere Modifikatoren berücksichtigen Erkrankungen, welche die Therapie maßgeblich beeinflussen, z. B. eine signifikante Osteoporose oder eine ankylosierende Wirbelsäulenerkrankung. Bisherige Untersuchungen zur Intra- und Interbegutachterkonsistenz haben vielversprechende Ergebnisse gezeigt, sodass die Einführung der AOSpine-Klassifikation für thorakolumbale Verletzungen in einer deutschen Übersetzung gerechtfertigt sinnvoll ist.

Abstract

Optimal treatment of injuries to the thoracolumbar spine is based on a detailed analysis of instability, as indicated by injury morphology and neurological status, together with significant modifying factors. A classification system helps to structure this analysis and should also provide guidance for treatment. Existing classification systems, such as the Magerl classification, are complex and do not include the neurological status, while the TLICS system has been accused of over-simplifying the influence of fracture morphology and instability. The AOSpine classification group has developed a new classification system, based mainly upon the Magerl and TLICS classifications, and with the aim of overcoming these drawbacks. This differentiates three main types of injury: Type A lesions are compression lesions to the anterior column; Type B lesions are distraction lesions of either the anterior or the posterior column; Type C lesions are translationally unstable lesions. Type A and B lesions are split into subgroups. The neurological damage is graded in 5 steps, ranging from a transient neurological deficit to complete spinal cord injury. Additional modifiers describe disorders which affect treatment strategy, such as osteoporosis or ankylosing diseases. Evaluations of intra- and inter-observer reliability have been very promising and encourage the introduction of this AOSpine classification of thoracolumbar injuries to the German speaking community.

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