Evaluation of the safety and reliability of the newly-proposed AO spine injury classification system

Abstract

Objective: To evaluate the safety and reliability of the new AO Classification, a recent classification system for Thoraco-Lumbar Spine Trauma (TLST). Design: Retrospective study. Methods: We applied the new AO system in patients with TLST treated according to the TLICS. Two researchers classified injuries independently. Eight weeks later, the classification was repeated for intra and inter-observer agreement evaluation. To evaluate safety, we correlated the treatment performed based on the TLICS with the newer AO classification obtained. Results: Fifty-four patients were included in this study, with a mean follow-up of 363.8 days. Twenty-three neurologically intact patients were initially treated conservatively. Their mean TLICS was 1.78 (1-4 points). Four patients underwent late surgery. Thirty-one patients were treated surgically. Their average TLICS was 7.22 points (4-10 points). Agreements in the four independent evaluations according to AO groups and subgroups were of 64.8% (35/54) and 55.5% (30/54) respectively. Kappa index for groups A, B and C was 0.75, 0.7 and 0.85 respectively. Kappa index for subgroups ranged from 0.16 to 0.85. Regarding safety, thirty (57.6%) patients with total subgroups agreement were analyzed. All patients with fracture in groups B and C underwent surgical treatment and patients in group A received surgery according to neurological status or failure of conservative treatment. Conclusion:The newer AO spine classification demonstrated good reliability at the level of groups. Subgroups demonstrated worse and varying reliability. Although the safety analysis was limited due to the low level of total concordance among all evaluations, patients from group A can be treated conservatively or surgically, whereas those from groups B and C are treated surgically.

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

“…The literature search identified 63 unique records, of which 17 were selected for the full-text review and 9 articles 3,20-27 were included in the final review (Figure 1). There was a substantial variation in the characteristics of included studies in terms of the number of observers and cases and imaging modalities (Table 1).…”

Epidemiology of Spinal Trauma Surgically Treated at the Unicamp Hospital Das Clínicas

“…16 The new morphological classifications based on these mechanisms proposed by AOSpine, [15][16][17] both of the subaxial cervical and thoracolumbar spines, were assessed by the authors and were shown to be reproducible and safe in the series evaluated. [18][19] Additionally, fractures can usually be classified as either stable or unstable. The concept of stability was defined by White and Panjabi 20 as the capacity of the spine to maintain alignment under physiological loads, without pain or neurological injury.…”

Is There an Association With Spino-Pelvic Relationships and Clinical Outcome of Type A Thoracic and Lumbar Fractures Treated Non-Surgically?

“…The spino-pelvic relationships evaluated, the final global spinal alignment, LL, and TK did not associate with outcome measures (ODI and SF 36 physical status) ( Table 3 and 4). Furthermore, while the study is undoubtedly limited because of the small size, the results of this study did not even find a trend; therefore, it is likely that these results truly represent no correlation and are not just the result of an underpowered study.…”

“…3 While there is no universally accepted treatment algorithm for A3 (burst fractures involving the posterior vertebral wall and a single endplate) and A4 fractures (burst fractures involving the posterior vertebral wall and both endplates), most commonly type A injuries without neurological deficits may be managed without surgery, with a low ris\k of late neurological deterioration. 2,4,5 While the short-term results of nonsurgical fracture management are known, the long-term outcomes of such treatment remain uncertain. 1 Nonsurgical treatment may yield residual deformity which, in turn, may lead to sagittal imbalance, pain, or functional disability.…”