A simplified treatment algorithm for treating thoracic and lumbar spine trauma.

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Abstract

[Indexed for MEDLINE] 18. Global Spine J. 2026 Jan;16(1):806-816. doi: 10.1177/21925682251366981. Epub 2025 Aug 27. Thoracolumbar Fractures: Historical Systems and Advancements With the AO Spine Classification. Kweh BTS(1)(2)(3), Vaccaro AR(4), Schroeder G(4), Canseco JA(4), Reinhold M(5), Aly MM(6), Bigdon S(7), El-Skarkawi M(8), Bransford RJ(9), Joaquim AF(10), Chhabra HS(11), Vialle E(12), Kanna RM(13), Dandurand C(14), Öner C(15), Tee JW(1)(2)(16). Author information: (1)National Trauma Research Institute, Melbourne, VIC, Australia. (2)Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia. (3)Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC, Australia. (4)Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA. (5)Department of Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria. (6)Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia. (7)Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland. (8)Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Egypt. (9)Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA. (10)Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas, Brazil. (11)Sri Balaji Action Medical Institute, New Delhi, India. (12)Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil. (13)Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India. (14)Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. (15)University Medical Centers, Utrecht, The Netherlands. (16)Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. Study DesignSystematic Review.ObjectiveTo describe the historical classifications of thoracolumbar injuries and their evolution into the AO Spine Thoracolumbar Injury Classification System.MethodsA systematic review of MEDLINE, EMBASE and Cochrane Databases was performed in keeping with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.Results445 articles were crystallized to 14 included studies. Simple categorization systems offered by Bohler or Watson-Jones merely identify fracture morphology. Holdsworth and Denis conveyed a sense of the stability of injuries by noting columns of stability, but still failed to take into consideration important factors such as neurological status or specific integrity of key stabilizing structures. The AO Spine Thoracolumbar Injury Classification System provides 3 hierarchical categories: type A consisting of compression type injuries, type B composed of distraction injuries and the unstable type C comprising displacement injuries. This communicates the severity of the fracture to clinicians and, with the addition of modifiers, can be synthesised into a scoring system to guide management. This classification is based upon biomechanical stability and increasing likelihood of clinicians offering operative rather than non-operative intervention as fracture severity escalates.ConclusionsA combination of evaluating fracture morphology, integrity of the posterior ligamentous complex and neurological status of the patient in the context of individual patient modifiers is integral to guide surgical decision making. The AO Thoracolumbar Injury Classification System accounts for all of the aforementioned and is the derivative and advancement on existing historical systems. Further nuanced development of scoring systems to guide operative or non-operative management is still required. DOI: 10.1177/21925682251366981 PMCID: PMC12391042