• Alexander R Vaccaro, Cumhur Oner, Christopher K Kepler, Marcel Dvorak, Klaus Schnake, Carlo Bellabarba, Max Reinhold, Bizhan Aarabi, Frank Kandziora, Jens Chapman, Rajasekaran Shanmuganathan, Michael Fehlings, Luiz Vialle, and AOSpine Spinal Cord Injury & Trauma Knowledge Forum.
• *Thomas Jefferson University and The Rothman Institute, Philadelphia, PA †University Medical Center, Utrecht, the Netherlands ‡Vancouver General Hospital, Vancouver, British Columbia, Canada §Unfallklinik Frankfurt am Main, Frankfurt, Germany ¶University of Washington, Seattle, WA ‖Medical University Innsbruck, Innsbruck, Austria **University of Maryland School of Medicine, Baltimore, MD ††Harborview Medical Center, Seattle, WA ‡‡Ganga Hospital, Coimbatore, Tamil Nadu, India §§University of Toronto, Toronto, Ontario, Canada; and ¶¶Catholic University, Curitiba, Brazil.
• Spine. 2013 Nov 1;38(23):2028-37.

Study DesignReliability and agreement study, retrospective case series.ObjectiveTo develop a widely accepted, comprehensive yet simple classification system with clinically acceptable intra- and interobserver reliability for use in both clinical practice and research.Summary Of Background DataAlthough the Magerl classification and thoracolumbar injury classification system (TLICS) are both well-known schemes to describe thoracolumbar (TL) fractures, no TL injury classification system has achieved universal international adoption. This lack of consensus limits communication between clinicians and researchers complicating the study of these injuries and the development of treatment algorithms.MethodsA simple and reproducible classification system of TL injuries was developed using a structured international consensus process. This classification system consists of a morphologic classification of the fracture, a grading system for the neurological status, and description of relevant patient-specific modifiers. Forty cases with a broad range of injuries were classified independently twice by group members 1 month apart and analyzed for classification reliability using the Kappa coefficient (κ).ResultsThe morphologic classification is based on 3 main injury patterns: type A (compression), type B (tension band disruption), and type C (displacement/translation) injuries. Reliability in the identification of a morphologic injury type was substantial (κ= 0.72).ConclusionThe AOSpine TL injury classification system is clinically relevant according to the consensus agreement of our international team of spine trauma experts. Final evaluation data showed reasonable reliability and accuracy, but further clinical validation of the proposed system requires prospective observational data collection documenting use of the classification system, therapeutic decision making, and clinical follow-up evaluation by a large number of surgeons from different countries.

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