Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

Conflict of interest statement: Conflict of Interest: None. 17. Eur Spine J. 2016 Apr;25(4):1087-94. doi: 10.1007/s00586-015-3982-2. Epub 2015 May 8. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Vaccaro AR(1), Schroeder GD(2), Kepler CK(2), Cumhur Oner F(3), Vialle LR(4), Kandziora F(5), Koerner JD(2), Kurd MF(2), Reinhold M(6), Schnake KJ(7), Chapman J(8), Aarabi B(9), Fehlings MG(10), Dvorak MF(11). Author information: (1)The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA. alexvaccaro3@aol.com. (2)The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA. (3)University Medical Center, Utrecht, The Netherlands. (4)Catholic University, Curitiba, Brazil. (5)Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Frankfurt/Main, Germany. (6)Klinikum Suedstadt Rostock, Department of Orthopaedic and Trauma Surgery, Suedring 81, 18059, Rostock, Germany. (7)Schön Klinik Nürnberg Fürth, Center for Spinal Therapy, Fürth, Germany. (8)The Swedish Neuroscience Institute, Seattle, WA, USA. (9)University of Maryland School of Medicine, Baltimore, MD, USA. (10)University of Toronto, Toronto, ON, Canada. (11)University of British Columbia, Vancouver, BC, Canada. Comment in Eur Spine J. 2016 Apr;25(4):1095-7. doi: 10.1007/s00586-015-4069-9. Eur Spine J. 2017 Aug;26(8):2214-2215. doi: 10.1007/s00586-017-5174-8. Eur Spine J. 2017 Aug;26(8):2216-2217. doi: 10.1007/s00586-017-5175-7. PURPOSE: The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar spine injury classification system. METHODS: 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. RESULTS: 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. CONCLUSION: 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. DOI: 10.1007/s00586-015-3982-2