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Thoracolumbar spine fractures - McAfee classification

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Wedged compression fracture

  • Isolated failure of the anterior column
  • Wedge-shaped vertebral body
  • Mechanism of injury: Forward flexion

Stable burst fracture

  • Anterior and middle columns fail
  • No loss of integrity of the posterior elements
  • Mechanism of injury: Compressive load

Unstable burst fracture

  • Anterior and middle columns fail in combination with disruption of the posterior column
  • Posterior column may fail in compression, lateral flexion, or rotation, but not in distraction
  • Tendency for post-traumatic kyphosis and progressive neural symptoms

Note: The importance of differentiating compression from burst fractures lies in the higher frequency of neurologic deficits associated with the latter.

Chance fracture

  • Horizontal avulsion injury of the vertebral body
  • Mechanism of injury: Flexion about an axis anterior to the anterior longitudinal ligament
  • Entire vertebral segment is pulled apart by strong tensile forces

Flexion-distraction injury

  • Compressive failure of the anterior column while the middle and posterior columns fail in tension
  • Mechanism of injury: Flexion about an axis posterior to the anterior longitudinal ligament
  • Tensile failure of the middle column results in tear or attenuation of the posterior longitudinal ligament
  • If the zygoapophyseal joint capsules are disrupted, subluxation, 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

Translational injury

  • All three columns have failed in shear
  • Displacement in the transverse plane with alignment disruption of the spinal canal
  • Includes Holdsworth’s slide fractures, rotational fracture-dislocations, and pure dislocations


The classification of acute traumatic spinal injuries by McAfee and colleagues1 is based on the three column concept of the spine. CT is mandatory for accurate assessment.


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Provide the citation for the landmark article and recent review articles describing the classification

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