Radiological Prediction of Posttraumatic Kyphosis After Thoracolumbar Fracture

Inez Curfs1, *, Bernd Grimm2, Matthijs van der Linde1, Paul Willems3, Wouter van Hemert1
1 Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre, Heerlen, The Netherlands
2 AHORSE Research Institute, Atrium Medical Center, Heerlen, The Netherlands
3 Department of Orthopaedic Surgery, MUMC, Maastricht, The Netherlands

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© Curfs et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery and Traumatology, Atrium Medical Center, Postbus 4446, 6401 CX Heerlen, The Netherlands; Tel: +31 45 576 67 47; E-mail:



Classification methods that are currently being used for clinical decision making in thoracolumbar fractures, are limited by reproducibility and prognostic value. Additionally, they do not include kyphosis. As a posttraumatic kyphosis is related to persistent pain, it is of importance to determine a risk of posttraumatic kyphosis based on fracture type and patient characteristics.


To determine risk factors (AO classification, age, gender, localization) that may lead to progressive kyphosis after a thoracolumbar fracture.

Materials and Methods:

Retrospective radiographic analysis of a consecutive patientcohort that presented in our clinic with a traumatic fracture of the thoracolumbar spine between 2004 and 2011. Cobb angle, Gardner angle, vertebral compression angle and anterior vertebral body compression were measured on plain radiographs, direct post-trauma and at follow-up.


Age and localization are not significantly correlated, but there seems to be an increased risk of progression of kyphosis in age > 50 years and fractures localized at Th12 or L1. A3 type fractures are significantly more at risk for posttraumatic kyphosis compared to A1 and A2 type fractures. 30-50% of the A3 type fractures have an end Gardner angle and end vertebral compression angle of more than 20 degrees.


AO-type A3 fractures appear to be at risk of progression of kyphosis. Localization at Th12-L1 and age above 50 years seem to be risk factors for significant posttraumatic kyphosis. These findings should be used in patient counseling and a meticulous evaluation by weekly radiographs is recommended to determine the treatment strategy of thoracolumbar fractures.

Keywords: Classification, fracture, fracture, prognosis, radiological prediction, spine, treatment.