The AOSpine thoracolumbar spine injury classification system: A comparative study with the thoracolumbar injury classification system and severity score in children

Abstract

Background: There is no uniform classification in the pediatric population for thoracolumbar (TL) fractures, nor any operative guidelines. This study evaluates the AOSpine TL spine injury classification in the pediatric population and compares it to the thoracolumbar injury classification system (TLICS), which has previously been validated in pediatric spine trauma. Methods: Twenty-eight patients with operative TL injuries were identified from 2006 to 2016. Inclusion criteria included available imaging, operative records, age <18, and posterior approach. Each case was classified by AOSpine TL spine injury classification and TLICS. Each classification was compared to documented intraoperative posterior ligamentous complex (PLC) integrity as well as each other. Results: Utilizing the AOSpine TL spine injury classification, 7 patients had type A injuries, 15 patients had type B injuries, and 6 patients had type C injuries; 21 patients had injuries classified as involving the PLC. Using TLICS, 16 patients had burst fractures, 6 patients had distraction injuries, and 6 patients had translation injuries; 21 patients had injuries classified as involving the PLC. Spearman correlation analysis substantiated convergence of AOSpine TL spine injury classification scores to TLICS scores ( r = 0.75; 95% confidence interval, CI = 0.51 to 0.98; P < .001). Concordance between PLC integrity by each classification and intraoperative evaluation was 96% (27/28) of cases ( k = 0.91; 95% CI = 0.73 to 1.08). Neurologic status was 100% concordant between the AOSpine TL spine injury classification and TLICS. Conclusion: There is high statistical correlation between the AOSpine TL spine injury classification and TLICS, and to intraoperative evaluation of the PLC, suggesting that the AOSpine TL spine injury classification is applicable to the pediatric population. Level of evidence: III.

Epidemiological Profile of Patients With Vertebral Trauma at a Reference Center in the Amazon

“…18,23 Conservative treatment was the most employed, reflecting the benign aspect of most of injuries, especially the lumbar ones, followed by arthrodesis, which was used more in injuries with signs of instability such as compression of vertebral canal, impacting over 50% of vertebral structure and vertebral translation. 24,25 Compared to previous decades, there were more positive outcomes, with a large increase in the number of people recovering without sequelae and a lower percentage of patients coming from rural areas of the state, indicating improvements in the efficiency of public health in Pará. However, the percentage of traffic accidents as the cause of vertebral trauma has increased, reinforcing the need for better awareness strategies and better infrastructure on the roads and highways.…”

Validation of the TLICS and AOSpine injury score for surgical management of paediatric traumatic spinal injuries

“…Conservative treatment options include observation or corset therapy. The decision for surgical treatment depends not only on factors such as fracture stability, displacement, and neurological status but also on the possible consequences of such fractures on the growing spine [ 2 , 3 ]. If these spinal injuries are not treated adequately, however, irreversible spinal deformities and sagittal imbalance can occur [ 3 ].…”

“…While the TLICS has been validated in the paediatric population, there are only a few studies in small patient cohorts comparing it to the AOSpine thoracolumbar spine injury classification [ 8 ]. Furthermore, in the existing literature, conflicting results with some studies finding superiority of the TLICS over the AOSpine injury score and others finding a high correlation between the two systems are presented [ 2 , 9 ].…”

The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: An international validation study

“… 6 - 8 In a previous study, TLICS and the AOSpine Thoracolumbar Spine Injury Classification system has been found to corelate when assessed in the peadiatric population. 9 …”

“…[6][7][8] In a previous study, TLICS and the AOSpine Thoracolumbar Spine Injury Classification system has been found to corelate when assessed in the peadiatric population. 9 The lead authors of this study previously assessed the inter-and intraobserver reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children with a single country cohort of observers. 10 The aim of this study was to confirm the interobserver reliability and intraobserver reproducibility of the AOSpine Thoracolumbar Spine Injury Classification System with an international cohort of observers when applied to the paediatric population on a global level, representing diverse patient populations and reviewers with diverse training backgrounds.…”