Document Type
Article
Publication Date
2-7-2024
Abstract
STUDY DESIGN: Prospective Observational Study.
OBJECTIVE: To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making.
METHODS: 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts. These experienced clinicians classified the fracture morphology, integrity of the posterior ligamentous complex and degree of comminution. Management recommendations were collected.
RESULTS: There was a statistically significant stepwise increase in rates of operative management with escalating category of injury (P < .001). An excellent correlation existed between recommended expert management and the actual treatment of each injury category: A0/A1/A2 (OR 1.09, 95% CI 0.70-1.69, P = .71), A3/4 (OR 1.62, 95% CI 0.98-2.66, P = .58) and B1/B2/C (1.00, 95% CI 0.87-1.14, P = .99). Thoracolumbar A4 fractures were more likely to be surgically stabilized than A3 fractures (68.2% vs 30.9%, P < .001). A modifier indicating indeterminate ligamentous injury increased the rate of operative management when comparing type B and C injuries to type A3/A4 injuries (OR 39.19, 95% CI 20.84-73.69, P < .01 vs OR 27.72, 95% CI 14.68-52.33, P < .01).
CONCLUSIONS: The AO Spine Thoracolumbar Injury Classification system introduces fracture morphology in a rational and hierarchical manner of escalating severity. Thoracolumbar A4 complete burst fractures were more likely to be operatively managed than A3 fractures. Flexion-distraction type B injuries and translational type C injuries were much more likely to have surgery recommended than type A fractures regardless of the M1 modifier. A suspected posterior ligamentous injury increased the likelihood of surgeons favoring surgical stabilization.
Recommended Citation
Kweh, Barry T.S.; Tee, Jin Wee; Dandurand, Charlotte; Vaccaro, Alexander R.; Lorin, Benneker M.; Schnake, Klaus; Vialle, Emiliano; Rajasekaran, Shanmuganathan; El-Skarkawi, Mohammad; Bransford, Richard J.; Kanna, Rishi M.; Aly, Mohamed M.; Holas, Martin; Canseco, Jose A.; Muijs, Sander; Popescu, Eugen C.; Camino-Willhuber, Gaston; Joaquim, Andrei F.; Chhabra, Harvinder S.; Bigdon, Sebastian Frederick; Spiegel, Ulrich; Dvorak, Marcel; Öner, Cumhur F.; and Schroeder, Gregory, "The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit" (2024). Rothman Institute Faculty Papers. Paper 248.
https://jdc.jefferson.edu/rothman_institute/248
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Language
English
Comments
This is the author's final published version in Global Spine Journal, Volume 14, Issue 1 Suppl, February 2024, Pg. 32S - 40S.
The published version is available at https://doi.org/10.1177/21925682231195764. Copyright © The Author(s) 2023.