The Faskit Classification System in Medical Practice
The Faskit classification system is not a recognized fracture classification system in medical practice; rather, thoracolumbar spine injury classification systems like TLICS/TLISS and AO Spine Thoracolumbar Spine Injury Classification System are recommended for guiding treatment decisions in thoracolumbar trauma. 1
Established Thoracolumbar Fracture Classification Systems
TLICS/TLISS (Thoracolumbar Injury Classification and Severity Scale)
- Focuses on both fracture morphology and the critical determinant of neurological examination 1
- Demonstrates good to excellent inter- and intraobserver reliability 1
- Helps guide treatment decisions, though it cannot yet be adapted to predict management in all thoracolumbar trauma populations 1
AO Spine Thoracolumbar Spine Injury Classification System
- Comprehensive yet simple scheme with greater reproducibility than prior systems 1
- Uses Magerl hierarchy of injury types with ascending severity 1:
- Type A: Compression injuries with preserved posterior ligamentous complex
- Type B: Failure of posterior or anterior tension band in distraction
- Type C: Disruption of all elements with displacement/dislocation
- Includes neurological grading component (N0-N4) and case-specific modifiers 1
Load Sharing Classification (LSC)
- Specifically helps guide treatment of burst fractures 1
- Evaluates three characteristics on CT 1:
- Comminution/involvement
- Apposition of fragments
- Correction of kyphotic deformity
- Point system determines treatment approach 1:
- 7-9 points: Likely benefit from both posterior and anterior approaches
6 points: Can be treated by posterior short-segment fixation alone
- Demonstrated clinical efficacy with good to excellent interobserver reliability 1
Cervical Spine Classification Systems
Subaxial Injury Classification (SLIC) System
- Provides excellent reliability for grading instability and fracture patterns in cervical spine injuries 2
- Incorporates assessment of discoligamentous complex integrity and neurological status 3
- SLIC score ≥5 indicates need for surgical intervention 3
Importance of Classification Systems in Fracture Management
- Classification systems are essential for clinical communication, treatment decisions, prognosis estimation, and comparing results 4
- Ideal classification systems should be reliable, reproducible, all-inclusive, mutually exclusive, logical, and clinically useful 4
- The validation process should assess the value of specific clinical information in increasing the probability of correct diagnosis 5
Limitations of Current Classification Systems
- Many classification systems were not developed or validated by rigorous scientific evaluation methods 5
- Some systems are overly comprehensive or inclusive, making them difficult to learn and use 1
- Others have fewer fracture types and subtypes, leaving gaps that don't allow descriptions of all fracture types 1
- Prospective research is lacking to demonstrate that using classification systems results in superior clinical outcomes compared to not using any system 1
Clinical Application
- The Congress of Neurological Surgeons recommends utilizing a thoracolumbar trauma classification scheme that uses readily available clinical data, such as TLICS/TLISS or AO Spine Thoracolumbar Spine Injury Classification System 1
- However, there is insufficient evidence to recommend a universal classification system that can guide treatment and affect outcomes of thoracolumbar injuries 1
- Classification systems should be evaluated for interobserver and intraobserver agreement to ensure reliability in clinical practice 6