The surgical algorithm for the AOSpine thoracolumbar spine injury classification system

Alexander R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler, F. Cumhur Oner, Luiz R. Vialle, Frank Kandziora, John D. Koerner, Mark F. Kurd, Max Reinhold, Klaus J. Schnake, Jens Chapman, Bizhan Aarabi, Michael G. Fehlings, Marcel F. Dvorak

The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar spine injury classification system. A survey was sent to AOSpine members from the six AO regions of the world, and surgeons were asked if a patient should undergo an initial trial of conservative management or if surgical management was warranted. The survey consisted of controversial injury patterns. Using the results of the survey, a surgical algorithm was developed. The AOSpine Trauma Knowledge forum defined that the injuries in which less than 30 % of surgeons would recommend surgical intervention should undergo a trial of non-operative care, and injuries in which 70 % of surgeons would recommend surgery should undergo surgical intervention. Using these thresholds, it was determined that injuries with a thoracolumbar AOSpine injury score (TL AOSIS) of three or less should undergo a trial of conservative treatment, and injuries with a TL AOSIS of more than five should undergo surgical intervention. Operative or non-operative treatment is acceptable for injuries with a TL AOSIS of four or five. The current algorithm uses a meaningful injury classification and worldwide surgeon input to determine the initial treatment recommendation for thoracolumbar injuries. This allows for a globally accepted surgical algorithm for the treatment of thoracolumbar trauma.