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Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.

While early analysis (four years) revealed few significant differences between the two groups, at long-term follow-up (sixteen to twenty-two years), those with a stable burst fracture who were treated nonoperatively reported less pain and better function compared with those who were treated surgically.

APJFs were identified in 5.6% of patients undergoing surgical treatment of adult spinal deformity, with failures occurring primarily in the TL region of the spine. There is evidence that the mode of failure differs depending on the location of UIV, with TL failures more likely due to fracture and UT failures more likely due to soft-tissue failures.

Although patient outcomes are similar, anterior fusion and instrumentation for thoracolumbar burst fractures may present fewer complications or additional surgeries.

Quantitative data on the range of in vivo vertebral motion is critical to enhance our understanding of spinal pathology and to improve the current surgical treatment methods for spinal diseases. Little data have been reported on the range of lumbar vertebral motion during functional body activities. In this study, we measured in vivo 6 degrees-of-freedom (DOF) vertebral motion during unrestricted weightbearing functional body activities using a combined MR and dual fluoroscopic imaging technique. Eight asymptomatic living subjects were recruited and underwent MRI scans in order to create 3D vertebral models from L2 to L5 for each subject. The lumbar spine was then imaged using two fluoroscopes while the subject performed primary flexion-extension, left-right bending, and left-right twisting. The range of vertebral motion during each activity was determined through a previously described imagingmodel matching technique at L2-3, L3-4, and L4-5 levels. Our data revealed that the upper vertebrae had a higher range of flexion than the lower vertebrae during flexionextension of the body (L2-3, 5.4 ± 3.8°; L3-4, 4.3 ± 3.4°; L4-5, 1.9 ± 1.1°, respectively). During bending activity, the L4-5 had a higher (but not significant) range of left-right bending motion (4.7 ± 2.4°) than both L2-3 (2.9 ± 2.4°) and L3-4 (3.4 ± 2.1°), while no statistical difference was observed in left-right twisting among the three vertebral levels (L2-3, 2.5 ± 2.3°; L3-4, 2.4 ± 2.6°; and L4-5, 2.9 ± 2.1°, respectively). Besides the primary rotations reported, coupled motions were quantified in all DOFs. The coupled translation in left-right and anterior-posterior directions, on average, reached greater than 1 mm, while in the proximal-distal direction this was less than 1 mm. Overall, each vertebral level responds differently to flexionextension and left-right bending, but similarly to the leftright twisting. This data may provide new insight into the in vivo function of human spines and can be used as baseline data for investigation of pathological spine kinematics.

Little is known about the natural history of spinal alignment as it ages into the eighth and ninth decades. Fifty asymptomatic volunteers 70-85 years of age (mean 76 years) without any history of spine pain, trauma, or deformity were radiographed in the standing lateral position, from C7 to the pelvis including the hips. Measurements included segmental angulations, kyphosis, lordosis, and C7 plumb line balance. In addition, measurements of sagittal pelvic balance were made (pelvic incidence, tilting, sacral slope, and S1 overhang). Average kyphosis was 52 degrees (range 29 degrees to 79 degrees); the average lordosis was -57 degrees (range -96 degrees to -20 degrees). The C7 plumb line on average fell 40 mm anterior to the posterosuperior corner of S1. The anterior positioning of C7 was also positively correlated with age and decreasing lordosis. This provides further data into the natural history of the aging spine.