White and Panjabi’s Classification

White and Panjabi’s classification is used to differentiate spinal pathology as per its stability in the cervical, thoracic, and lumbar spine i.e. for diagnosis of spinal instability

Remember 4 D common to all, 3 D- for the cervical Spine, 1 D for the lumbar spine

Diagnosis requires: Score >4

Denis column disruption

1. Anterior column is destroyed or unable to function (2 points)
2. Posterior column is destroyed or unable to function (2 points)

Deformity 

Will have a maximum score of 4 points (2 points assigned for ART – Angulation, Rotation, and Translation each)

1. Sagittal plane translation/displacement: 2 points
   • C-spine: >3.5 mm or 20% in flexion-extension or resting X-rays
   • T-spine: >2.5 mm
   • L-spine: >4.5 mm or 15% in flexion-extension or resting X-rays
   • Mnemonic: Remember C/T/L – 3.5/2.5/4.5
2. Sagittal plane rotation in flexion-extension X-rays: 2 points
   • C-spine: >20 degrees
   • L-spine:
     1. >15 degrees at L1-L2, L2-L3, and L3-L4
     2. >20 degrees at L4-L5
     3. >25 degrees at L5-S1
     4. Mnemonic: Multiply by 5 (L3: 3X5 = 15; L4: 4X5 = 20; L5: 5X5 = 25)
3. Sagittal plane angulation (relative) in resting X-rays: 2 points
   • C-spine: >11 degrees
   • T-spine: >5 degrees
   • L-spine: >22 degrees

Damage to spinal cord/nerve root:

1. C-spine: Spinal cord damage (2 points) and Nerve root damage (1 point)
2. T-spine: Spinal cord damage (2 points)
3. L-spine: Cauda equina syndrome (3 points)

Dangerous loading anticipated: 

1 point

Some specific points in White and Panjabi’s classification

Specific to C-Spine

Specific to T- Spine

Distraction test (Stretch test) positive: 2 pointsLateral view X-ray or C-arm with Crutchfield tong traction or head-halter traction with 5 pounds of weight increment every 5 minutes (up to 1/3 of body weight) until the test is positive (neurologic deficit or abnormal separation of anterior and posterior elements)Developmentally narrow spinal canal (Sagittal diameter <13 mm or Pavlov’s ratio <0.8): 1 pointsDisc narrowing (abnormal): 1 point

Disarticulation of costovertebral articulation: 1 point

See also: Spinal tuberculosis (Pott’s Spine)

See also: Late-Onset Paraplegia/ Paraplegia of Healed disease

See also: Thoracolumbar Spinal Injury

See also: Approaches (Spine)

See also: Cervical Spinal Injuries

See also: Scoliosis