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AO spine injury classification system: a revision proposal for the thoracic and lumbar spine

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Abstract

Purpose

The AO Spine Classification Group was established to propose a revised AO spine injury classification system. This paper provides details on the rationale, methodology, and results of the initial stage of the revision process for injuries of the thoracic and lumbar (TL) spine.

Methods

In a structured, iterative process involving five experienced spine trauma surgeons from various parts of the world, consecutive cases with TL injuries were classified independently by members of the classification group, and analyzed for classification reliability using the Kappa coefficient (κ) and for accuracy using latent class analysis. The reasons for disagreements were examined systematically during review meetings. In four successive sessions, the system was revised until consensus and sufficient reproducibility were achieved.

Results

The TL spine injury system is based on three main injury categories adapted from the original Magerl AO concept: A (compression), B (tension band), and C (displacement) type injuries. Type-A injuries include four subtypes (wedge-impaction/split-pincer/incomplete burst/complete burst); B-type injuries are divided between purely osseous and osseo-ligamentous disruptions; and C-type injuries are further categorized into three subtypes (hyperextension/translation/separation). There is no subgroup division. The reliability of injury types (A, B, C) was good (κ = 0.77). The surgeons’ pairwise Kappa ranged from 0.69 to 0.90. Kappa coefficients κ for reliability of injury subtypes ranged from 0.26 to 0.78.

Conclusions

The proposed TL spine injury system is based on clinically relevant parameters. Final evaluation data showed reasonable reliability and accuracy. Further validation of the proposed revised AO Classification requires follow-up evaluation sessions and documentation by more surgeons from different countries and backgrounds and is subject to modification based on clinical parameters during subsequent phases.

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Acknowledgments

The spine injury classification project was funded by the AO Foundation and its AOSpine Specialty. The authors would like to greatly thank Mary Anne Smith (AOSpine International) for the administrative support as well as Jecca Reichmuth and her colleagues at AO Education (Publishing) for the preparation of illustrations. The authors are grateful to all surgeons (as listed below in alphabetic order) who participated and provided fruitful support in any of the successive review meeting or classification sessions : Anderson P.A., USA; Bellabarba C., USA; Blauth M., Austria; Cisneros F.A., Mexico; Dai L.-Y., China; Hadley M., USA; Magerl F., Austria; Marré B., Chile; Matta J., Colombia; Oner C., The Netherlands; Reinhold M., Austria; Schnake K., Germany; van Middendorp J., The Netherlands; Zhou F., China. We would also like to greatly thank Melissa Wilhelmi for editing support of this manuscript.

Conflict of interest

  None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Maximilian Reinhold

  2. AO Foundation, AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600, Duebendorf, Switzerland

    Laurent Audigé

  3. Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Friedberger Landstrasse 430, 60389, Frankfurt/Main, Germany

    Klaus John Schnake

  4. Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359798, Seattle, WA, 98104, USA

    Carlo Bellabarba

  5. Shanghai Jiaotong University School of Medicine, Xinhua Hospital, 1665 Kong Jiang Road, Shanghai, 200092, China

    Li-Yang Dai

  6. School of Medicine, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    F. Cumhur Oner

Authors
  1. Maximilian Reinhold
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  2. Laurent Audigé
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  3. Klaus John Schnake
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  4. Carlo Bellabarba
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  5. Li-Yang Dai
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  6. F. Cumhur Oner
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Corresponding author

Correspondence to Laurent Audigé.

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Reinhold, M., Audigé, L., Schnake, K.J. et al. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J 22, 2184–2201 (2013). https://doi.org/10.1007/s00586-013-2738-0

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  • DOI: https://doi.org/10.1007/s00586-013-2738-0

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