Background: Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and
neurological deficit. Injuries to thoracolumbar spine are usually the result of high-energy blunt trauma. Majority of
thoracolumbar spine fractures occur due to falls from a height and motor vehicle injuries. The AO Spine thoracolumbar spine
injury classification system separates fractures into three major types: type A—compression injuries; type B—tension band
injuries and type C—translational injuries. Type A and B injuries are further subdivided into five and three subtypes,
respectively. Next the neurologic status of the patient is evaluated and classified: N0—neurologically intact patient; N1—
resolved transient neurological symptoms; N2—persistent radicular symptoms; N3—incomplete spinal cord injury or cauda
equina injury; N4—complete spinal cord injury and NX— neurologic exam is unobtainable. Objectives: This study applied AO
Spine classification system on patients with traumatic thoracolumbar spine fractures referred to Benha University Hospitals and
clarifying its role on management, decision making and outcome of those patients. Methods: This prospective study was
conducted to apply AO Spine injury classification system on patients with traumatic thoracolumbar spine fractures referred to
Benha University Hospitals and was utilized to describe each spine fracture and to aid decision making and management of those
patients. For one year between April 2021 and April 2022, 92 selected patients referred to Benha University Hospitals with acute
traumatic thoracolumbar spine fractures were included in this study. Those patients were categorized into two groups according
to their management either conservative or surgical based on AO Spine injury score. Results: The majority of the patients had no
associated trauma to other systems rather than thoracolumbar fractures. L1 level was found to be the most common neurological
level on admission detected in 36 cases (39.1%) then L2 level in 14 cases (15.2%). Back pain was the main presentation in
thoracolumbar spine fractures that improved in clinical follow up. About 80% of patients were neurologically intact. A1 was the
most common fracture description according to AO Spine classification on admission detected in 28 cases (30.4%) followed by
A3 in 16 cases (17.4%) and B2 in 15 cases (16.3%). N0 was the most common neurological description according to AO Spine
classification on admission detected in 59 cases (64.1%) followed by N3 in 16 cases (17.4%) and N2 in 10 cases (10.9%). The
mean AO Spine Classification score was 4.2. About one third of patients (33.7%) were treated surgically and two thirds of
patients (66.3%) were treated conservative according to AO Spine Classification Score. There was no change in decision making
from conservative cases to surgical cases. The Mean of angle of kyphosis improved and decreased from 12.2 to 11.4 during
follow up. About 95.5% of patients had minimal disability on 6th month follow up. Conclusion: The AO Spine thoracolumbar
spine injury classification system represents a carefully developed, simple and comprehensive scheme that well classify
thoracolumbar spine fractures and help surgeons to make good decision and management. Morphological description is critical to
detect PLC affection and instability but neurological status is critical to determine the need for surgery. |
