• Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler, Cumhur Oner F F University Medical Center, Utrecht, The ... more Netherlands., Luiz R Vialle, Frank Kandziora, John D Koerner, Mark F Kurd, Max Reinhold, Klaus J Schnake, Jens Chapman, Bizhan Aarabi, Michael G Fehlings, and Marcel F Dvorak. less
• The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA. alexvaccaro3@aol.com.
• Eur Spine J. 2016 Apr 1; 25 (4): 1087-94.

PurposeThe goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar spine injury classification system.MethodsA 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.ResultsThe 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.ConclusionThe 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.

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