title: Can a Thoracolumbar Injury Severity Score Be Uniformly Applied from T1 to L5 or Are Modifications Necessary?
abstract: Study Design Literature review. Objective The aim of this review is to highlight challenges in the development of a comprehensive surgical algorithm to accompany the AOSpine Thoracolumbar Spine Injury Classification System. Methods A narrative review of the relevant spine trauma literature was undertaken with input from the multidisciplinary AOSpine International Trauma Knowledge Forum. Results The transitional areas of the spine, in particular the cervicothoracic junction, pose unique challenges. The upper thoracic vertebrae have a transitional anatomy with elements similar to the subaxial cervical spine. When treating these fractures, the surgeon must be aware of the instability due to the junctional location of these fractures. Additionally, although the narrow spinal canal makes neurologic injuries common, the small pedicles and the inability to perform an anterior exposure make decompression surgery challenging. Similarly, low lumbar fractures and fractures at the lumbosacral junction cannot always be treated in the same manner as fractures in the more cephalad thoracolumbar spine. Although the unique biomechanical environment of the low lumbar spine makes a progressive kyphotic deformity less likely because of the substantial lordosis normally present in the low lumbar spine, even a fracture leading to a neutral alignment may dramatically alter the patient's sagittal balance. Conclusion Although the new AOSpine Thoracolumbar Spine Injury Classification System was designed to be a comprehensive thoracolumbar classification, fractures at the cervicothoracic junction and the lumbosacral junction have properties unique to these junctional locations. The specific characteristics of injuries in these regions may alter the most appropriate treatment, and so surgeons must use clinical judgment to determine the optimal treatment of these complex fractures.
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: John D
authors.initials: JD
authors.lastname: Koerner
authors.affiliation: Department of Orthopaedic Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: F Cumhur
authors.initials: FC
authors.lastname: Oner
authors.affiliation: Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, United States.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: Schön Klinik Nürnberg Fürth, Center for Spinal Surgery, Department of Orthopaedic Surgery, Fürth, Germany.
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Schnake
authors.affiliation: Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: Shanmuganathan
authors.initials: S
authors.lastname: Rajasekaran
authors.affiliation: Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Department of Orthopaedic Surgery, Frankfurt/Main, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Kandziora
authors.affiliation: Department of Orthopaedic Surgery, Catholic University, Curitiba, Brazil.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Vialle
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
keywords: AOSpine Thoracolumbar Spine Injury Classification System; cervicothoracic junction; low lumbar burst fractures; lumbosacral fractures; thoracolumbar trauma