title: Controversies in Spinal Trauma and Evolution of Care.
abstract: Management of spinal trauma is a complex and rapidly evolving field. To optimize patient treatment algorithms, an understanding of and appreciation for current controversies and advancing technologies in the field of spinal trauma is necessary. Therefore, members of the AOSpine Knowledge Forum Trauma initiative used a modified Delphi method to compile a list of controversial issues and emerging technologies in the field of spinal trauma, and a list of the 14 most relevant topics was generated. A total of 45 440 manuscripts covering the breadth of spine and spinal trauma were initially identified. This broad search was then refined using the 14 categories felt to be most relevant to the current field of spinal trauma. The results were further pared down using inclusion criteria to select for the most relevant topics. The 8 remaining topics were classification schemes, treatment of vertebral compression fractures, treatment of burst fractures, timing of surgery in spinal trauma, hypothermia, the importance of global sagittal balance, lumbar subarachnoid drainage, and diffusion magnetic resonance imaging. These 8 topics were felt to be the most relevant, controversial, rapidly evolving, and most deserving of inclusion in this summary. In summary, despite recent advances, the field of spinal trauma has many ongoing points of controversy. We must continue to refine our ability to care for this patient population through education, research, and development. It is anticipated that the new AOSpine fracture classification system will assist with prospective research efforts.
authors.affiliation: Department of Neurological Sur-gery, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.affiliation: Department of Neurological Sur-gery, Thomas Jefferson University, Philadelphia, Pennsylvania.|Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: George N
authors.initials: GN
authors.lastname: Rymarczuk
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, Toronto, Canada.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Tetreault
authors.affiliation: Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, Toronto, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D006801:Humans; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D013124:Spinal Injuries / Q000209:etiology / Q000473:pathology / Q000628:therapy*
keywords: Classification; Future; Imaging; Spine; Timing of surgery; Trauma