McAfee classification of thoracolumbar spinal fractures

McAfee classification of acute traumatic spinal injuries is one of a number of thoracolumbar spinal fracture classification systems and based on the three-column concept of the spine (of Denis). It requires CT for an accurate assessment.


The McAfee classification uses terminology that is understandable to most clinicians, even if they are not aware of the classification system itself. Unlike the more common formal classification systems (thoracolumbar injury classification and severity score (TLICS) and AO classification of thoracolumbar injuries) that have an explicit and precise classification and points schemes, the McAfee classification focuses on useful descriptive terms.


  • wedge compression: isolated anterior column compression (see wedge fracture)
  • stable burst: anterior and middle column compression but the posterior column is normal (see burst fracture)
  • unstable burst: anterior and middle column compression with disrupted posterior column
  • flexion-distraction 
    • anterior column compression
    • middle and posterior column: tensile failure
    • axis of flexion: posterior to anterior longitudinal ligament
  • chance fractures
    • pure bony injuries that extend all the way through the spinal column: from posterior to anterior through the spinous process, pedicles, and vertebral body, respectively (see chance fracture)
    • axis of flexion: anterior to anterior longitudinal ligament
  • translational fractures