title: The surgical algorithm for the AOSpine thoracolumbar spine injury classification system.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA. alexvaccaro3@aol.com.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: University Medical Center, Utrecht, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Cumhur Oner
authors.affiliation: Catholic University, Curitiba, Brazil.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Vialle
authors.affiliation: Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Frankfurt/Main, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Kandziora
authors.affiliation: The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Koerner
authors.affiliation: The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, 5th floor, Philadelphia, PA, 19107, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Kurd
authors.affiliation: Klinikum Suedstadt Rostock, Department of Orthopaedic and Trauma Surgery, Suedring 81, 18059, Rostock, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Reinhold
authors.affiliation: Schön Klinik Nürnberg Fürth, Center for Spinal Therapy, Fürth, Germany.
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Schnake
authors.affiliation: The Swedish Neuroscience Institute, Seattle, WA, USA.
authors.forename: Jens
authors.initials: J
authors.lastname: Chapman
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
mesh_terms: D000465:Algorithms; D003657:Decision Making; D003697:Delphi Technique; D014943:Global Health; D019538:Health Care Surveys; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D011364:Professional Practice / Q000706:statistics & numerical data; D016103:Spinal Fractures / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D013124:Spinal Injuries / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery
keywords: AOSpine thoracolumbar spine injury classification system; Spine trauma; TL AOSIS; Thoracolumbar trauma; Thoracolumbar trauma treatment algorithm