Klassifikation von Frakturen im thorakolumbalen Bereich nach Denis



Typ AFracture of both end plates (...). (...) it is seen in the low lumbar region. It does not lead to kyphosis. Its mechanism is pure axial load. The importance of recognizing it resides in the fact that decompression needs to be done at two levels (between the involved vertebra and both adjacent vertebrae).
Typ BFracture of the superior end-plate (...). This is the most frequent burst fracture. It is seen at the thoracolumbar junction. The C.A.T. scan demonstrates well burst of the
upper end-plate and frequently shows a sagittal split of the lower end-plate. The mechanism of injury is axial load and flexion. When indicated, decompression will be done at the upper level, between the burst vertebra and the vertebra above.
Typ CFracture of the inferior end-plate. This fracture is rare and, therefore, no particular site pattern could be located. The mechanism of injury appears to be also axial load and flexion. 
Typ DBurst rotation (...). This is typically a midlumbar fracture which could be misdiagnosed for a fracture dislocation due to the rotational malalignment of the spine. However, it presents all the pathognomonics of the burst fracture, including comminution of the vertebral body, increase of the interpediculate distance, vertical fracture of the lamina, bone retropulsed into the canal, loss of posterior
height, and a large central defect on myelogram as well as on C.A.T. scan. The mechanism of injury in this case is axial load and rotation.
Typ EBurst lateral flexion (...). This fracture results from axial load and lateral flexion. It differs from the lateral compression fracture in that the posterior wall of the vertebral body fractures, allowing retropulsion of bone back into the canal. One notes on C.A.T. scan that the extruded fragment is usually lateralized to the side towards which lateral flexion took place. The importance of differentiating the lateral burst from the lateral compression fracture resides in the potential neurological deficit either present or to be anticipated in the former and absent in the latter.