Computed Tomography Fracture Patterns, Treatment Approaches, and AO Spine Thoracolumbar Injury Classification Concordance in Thoracolumbar Spine Trauma at Kilimanjaro Christian Medical Center

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Abstract

ABSTRACT Aim: This study evaluated computed tomography (CT) fracture patterns, treatment approaches, and the association between fracture patterns and management, while assessing concordance between AO thoracolumbar Injury severity score (AOSTSIC) recommendations and actual management among thoracolumbar trauma patients at Kilimanjaro Christian Medical Centre (KCMC) from 2022 to 2024. Methodology: A hospital-based retrospective cross-sectional study was conducted on patients with thoracolumbar spine trauma treated at Kilimanjaro Christian Medical Centre (KCMC) between January 2022 and December 2024. Data were collected and analyzed using SPSS version 25. Descriptive statistics summarized social demographics, computed tomography (CT) fracture patterns and management approaches, while logistic regression generated odds ratios (OR), 95% confidence intervals, and p-values of 0.05 as cut off level of statistical significance for associations between fracture patterns and treatment. Results: A total of 166 patients were reviewed, median age 36 years (IQR: 28–52), predominantly male (87.9%), mostly from rural areas (57.8%) and self-employed (71.1%). Falls were the leading mechanism of injury (56.6%), and 76.5% had associated injuries. The thoracolumbar junction, particularly L1 (22.5%), was most frequently affected. AO Spine classification revealed Type A1 (27.7%) and Type C (18.7%) as most common. Overall, 53.1% received conservative management, and 46.9% underwent surgery. Complex fractures (A2: OR=48.0, 95% CI: 3.65–631.76, p=0.003; A3, A4, B, C) were significantly associated with surgical intervention. Substantial agreement existed between AOSTSIC recommendations and actual management (Kappa = 71.1%, p<0.001). Conclusions: Thoracolumbar trauma at Kilimanjaro Christian Medical Centre predominantly affects young adult males, with falls being the leading cause. Type A fractures, particularly A1, were the most common injury pattern, with L1 as the most frequently involved level. Severe fracture patterns were more likely to require surgical management, although access to surgery was sometimes limited. The AO Spine Thoracolumbar Injury Classification showed strong concordance with the treatment provided, supporting its usefulness in guiding management in resource-limited settings. Integration of the AO Spine Thoracolumbar Injury Classification and Severity Score into routine trauma care may help standardize clinical decision-making, while improving access to spinal implants through strengthened national health insurance coverage could reduce financial barriers to surgical management.