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
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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.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery |
UniBE Contributor: |
Bigdon, Sebastian |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2192-5682 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
13 Feb 2024 09:07 |
Last Modified: |
13 Feb 2024 13:07 |
Publisher DOI: |
10.1177/21925682231195764 |
PubMed ID: |
38324601 |
Uncontrolled Keywords: |
AO spine thoracolumbar injury classification AOSIS burst fracture spine trauma thoracolumbar injury classification score thoracolumbar trauma |
BORIS DOI: |
10.48350/192666 |
URI: |
https://boris.unibe.ch/id/eprint/192666 |
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