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Global Spine J. 2016 Jun;6(4):329-34. doi: 10.1055/s-0035-1563610. Epub 2015 Sep 29.

The Thoracolumbar AOSpine Injury Score.

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Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Department of Orthopaedic Surgery, Catholic University, Curitiba, Brazil.
Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, United States.
Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
Department of Orthopaedic Surgery, University of Washington, Seattle, Washington, United States.
Department of Orthopaedic Surgery, The Swedish Neuroscience Institute, Seattle, Washington, United States.
Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt, Frankfurt/Main, Germany.
Center for Spinal Surgery, Schön Klinik Nürnberg Fürth, Fürth, Germany.
Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Orthopaedic Surgery, University Medical Center, Utrecht, The Netherlands.


Study Design Survey of 100 worldwide spine surgeons. Objective To develop a spine injury score for the AOSpine Thoracolumbar Spine Injury Classification System. Methods Each respondent was asked to numerically grade the severity of each variable of the AOSpine Thoracolumbar Spine Injury Classification System. Using the results, as well as limited input from the AOSpine Trauma Knowledge Forum, the Thoracolumbar AOSpine Injury Score was developed. Results Beginning with 1 point for A1, groups A, B, and C were consecutively awarded an additional point (A1, 1 point; A2, 2 points; A3, 3 points); however, because of a significant increase in the severity between A3 and A4 and because the severity of A4 and B1 was similar, both A4 and B1 were awarded 5 points. An uneven stepwise increase in severity moving from N0 to N4, with a substantial increase in severity between N2 (nerve root injury with radicular symptoms) and N3 (incomplete spinal cord injury) injuries, was identified. Hence, each grade of neurologic injury was progressively given an additional point starting with 0 points for N0, and the substantial difference in severity between N2 and N3 injuries was recognized by elevating N3 to 4 points. Finally, 1 point was awarded to the M1 modifier (indeterminate posterolateral ligamentous complex injury). Conclusion The Thoracolumbar AOSpine Injury Score is an easy-to-use, data-driven metric that will allow for the development of a surgical algorithm to accompany the AOSpine Thoracolumbar Spine Injury Classification System.


AOSpine; AOSpine injury score; TL AOSIS; thoracolumbar spine injury classification system; thoracolumbar trauma

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