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ECR 2019 / C-3486
Let´s speak the same language: AOSpine Thoracolumbar Spine Injury Classification System
Congress: ECR 2019
Poster No.: C-3486
Type: Educational Exhibit
Keywords: Trauma, Education, Decision analysis, MR, CT, Conventional radiography, Musculoskeletal spine, Neuroradiology spine
Authors: V. Pantoja Ortiz1, V. Martin Garcia2, C. A. Marichal Hernández1, M. Fdez. del Castillo Ascanio1, Y. El Khatib Ghzal1, S. Benítez Rivero1, D. Eiroa1, N. Núñez Vila1, R. D. MEDINA HERRERA1; 1Santa Cruz de Tenerife/ES, 2STA CRUZ DE TENERIFE/ES


Throughout history there have been numerous classifications of bone lesions that have sought to catalog such lesions in order to guide treatment and prognosis [1-5].

Regarding spinal column injuries, the most traditional classification systems are that proposed by Francis Denis, the International Osteosynthesis Association (AO) classification presented by Magerl and Max Aebi and the Thoracolumbar Injury Severity Score (TLISS) postulated by Dr. Alexander Vaccaro, which gives a score according to the severity of the injury produced by thoracolumbar trauma [5, 6, 7].

However, to date, no classification has achieved a universal consensus to standardize care. This is probably due to the fact that no single classification system has been described that fully covers lesion severity, pathogenesis and biomechanical mechanisms of spinal injury and takes into account all clinical, neurological and radiological characteristics [8].

The lack of consensus can limit communication between physicians and make it difficult to fully understand the lesion that has patient, making more complicated the planning and development of treatment algorithms.

Previous published classifications have been criticized for being too simple, too complex or insufficiently reproducible.


AoSpine is an international academic community dedicated to research and education in the field of spinal care with the goal of unifying criteria in spinal care. They established the AO Spine Classification Group (AOSCG) with the aim to propose a comprehensive, evidence-based classification for traumatic spinal injuries that attempts to universalize the nomenclature and typing of spinal fractures. To this end, they have used the current Magerl AO system as a starting point and have tried to address traumatic spinal cord injuries in a way that is useful for clinical practice and research. [9,10].


In this communication we will focus on thoracolumbar (TL) fractures because they are the most frequent fractures of the spine. Due to its anatomical characteristics, the TL spine is particularly prone to fractures.


Several studies have found that the AOSpin classification presents a higher reliability than the traditional classifications, which present a moderate reliability and repeatability [4, 6, 9,11,12].

On the other hand, the data published by Wood et al. [12] regarding well-trained and experienced spine surgeons who classified the same fracture differently are striking.

There are several distinguishing characteristics that differentiate the AO spine injury classification system from the previous injury classifications [9]:

  • The AOSCG is composed of a core team of expert spine surgeons from diverse geographic and cultural backgrounds. This facilitates international understanding and the exchange of intercultural differences in learning and understanding of basic concepts and definitions.
  • Evidence-based approach. This classification system has been subjected to a solid process of statistical validation that guarantees a truly evidence-based approach towards an internationally accepted classification system [8].
  • Administration and follow-up study. The management of the entire process was coordinated by professional research organization (AOCID) which represents a quality control measure through an independent entity.
  • Experience in fracture classification. The AOSCG team has more than 50 years of experience in the use of spinal injury classifications.



Diagnostic imaging is the main basis for the characterization and categorization of spinal injuries that can be identified very reliably thanks to the remarkable advances achieved in radiology [9], however it should be noted that the different modalities of diagnostic imaging and the variable quality of the image can have a great impact on a classification of traumatism of the spine and result in different degrees of detail with respect to the bone structures and / or disc-ligaments involved in the injury [13].

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