Reliability and Validity of the AOSpine Thoracolumbar Injury Classification System: A Systematic Review.

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Abstract

Conflict of interest statement: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Disclosures outside of submitted work: ZB-consultancy: Xenco Medical, AO Spine; Research Support: SeaSpine (paid to the institution) JCW-JCW – Royalties – Biomet, Seaspine, Amedica, DePuy Synthes; Investments/Options – Fziomed, Promethean, Paradigm Spine, Benvenue, Nexgen, Vertiflex, Electrocore, Surgitech, Expanding Orthopedics, Osprey, Bone Biologics, Pearldiver; Board of Directors - North American Spine Society, North American Spine Foundation, AO Foundation, Cervical Spine Research Society; Fellowship Funding (paid to institution): AO Foundation. 12. World J Radiol. 2015 Sep 28;7(9):253-65. doi: 10.4329/wjr.v7.i9.253. Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review. Gamanagatti S(1), Rathinam D(1), Rangarajan K(1), Kumar A(1), Farooque K(1), Sharma V(1). Author information: (1)Shivanand Gamanagatti, Deepak Rathinam, Krithika Rangarajan, Atin Kumar, Department of Radiology, JPNA Trauma Center, AllIndia Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen (AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types (A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score (TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management. DOI: 10.4329/wjr.v7.i9.253 PMCID: PMC4585949