Klassifikation einer Wirbelsäulenverletzung nach McAfee et al.



compression fracture
Injury causing isolated failure of the anterior column. This fracture results from forward flexion and is rarely associated with neural loss except when it occurs in multiple adjacent vertebral levels. The vertebral body or bodies usually are wedge-shaped.
Stable burst fractureAnterior and middle columns fail because of a compressive load, with no loss of integrity of the posterior elements
Unstable burst fracture
Anterior and middle columns fail in compression and the posterior column is disrupted. The posterior column can fail in compression, lateral flexion, or rotation, but because of the instability there is a tendency for post-traumatic kyphosis and progressive neural symptoms to develop. Because the anterior and middle columns fail in compression, the posterior column cannot fail in distraction.
Chance fractureHorizontal avulsion injury of the vertebral body as a result of flexion about an axis anterior to the anterior longitudinal ligament, so that the entire expanse of the vertebra is pulled apart by strong tensile forces.
Flexion-distraction injuryFlexion axis is posterior to the anterior longitudinal ligament. There is compressive failure of the anterior column while the middle and posterior columns fail in tension. Tensile failure of the middle column results in a tear or attenuation of the posterior longitudinal ligament. If the zygoapophyseal joint capsules are disrupted there may be subluxation or dislocation of the facet joints, or fracture of the facets can occur. Most varieties of this injury are potentially unstable because the ligamentum flavum, interspinous ligament, and supraspinous ligament usually are torn.
The alignment of the neural canal has been disrupted. At the affected level one part of the spinal column has been displaced in the transverse plane. Usually all three columns have failed in shear. This category of injury includes Holdsworth's so-called slice fractures as well as rotational fracture-dislocations and pure dislocations.