The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit.

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; ... (2024). The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit. Global spine journal, 14(1_suppl), 32S-40S. Sage 10.1177/21925682231195764

Preview

Text kweh-et-al-2024-the-ao-spine-thoracolumbar-injury-classification-system-and-treatment-algorithm-in-decision-making-for.pdf - Published Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (595kB) | Preview

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.

Interest & Impact

Downloads

52 since deposited on 13 Feb 2024
52 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item