European Spine Journal

, Volume 25, Issue 4, pp 1087–1094 | Cite as

The surgical algorithm for the AOSpine thoracolumbar spine injury classification system

  • Alexander R. VaccaroEmail author
  • Gregory D. Schroeder
  • Christopher K. Kepler
  • F. Cumhur Oner
  • Luiz R. Vialle
  • Frank Kandziora
  • John D. Koerner
  • Mark F. Kurd
  • Max Reinhold
  • Klaus J. Schnake
  • Jens Chapman
  • Bizhan Aarabi
  • Michael G. Fehlings
  • Marcel F. Dvorak
Original Article



The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar spine injury classification system.


A survey was sent to AOSpine members from the six AO regions of the world, and surgeons were asked if a patient should undergo an initial trial of conservative management or if surgical management was warranted. The survey consisted of controversial injury patterns. Using the results of the survey, a surgical algorithm was developed.


The AOSpine Trauma Knowledge forum defined that the injuries in which less than 30 % of surgeons would recommend surgical intervention should undergo a trial of non-operative care, and injuries in which 70 % of surgeons would recommend surgery should undergo surgical intervention. Using these thresholds, it was determined that injuries with a thoracolumbar AOSpine injury score (TL AOSIS) of three or less should undergo a trial of conservative treatment, and injuries with a TL AOSIS of more than five should undergo surgical intervention. Operative or non-operative treatment is acceptable for injuries with a TL AOSIS of four or five.


The current algorithm uses a meaningful injury classification and worldwide surgeon input to determine the initial treatment recommendation for thoracolumbar injuries. This allows for a globally accepted surgical algorithm for the treatment of thoracolumbar trauma.


TL AOSIS AOSpine thoracolumbar spine injury classification system Thoracolumbar trauma Thoracolumbar trauma treatment algorithm Spine trauma 



This work was supported by AOSpine. AOSpine is a clinical division of the AO Foundation—an independent medically guided not-for-profit organization. The AO has a strong financial independence thanks to the foundations endowment. The annual operating activities are financed through three pillars: Collaboration and support agreements with DePuy Synthes and other industrial partners, return on own financial assets, and other third party income (e.g., participant fees, R&D projects, memberships). The AOSpine Knowledge Forums are pathology focused working groups acting on behalf of AOSpine in their domain of scientific expertise. Each forum consists of a steering committee of up to 10 international spine experts who meet biannually to discuss research, assess the best evidence for current practices, and formulate clinical trials to advance their field of spine expertise. Authors are compensated for their travel and accommodation costs. Study support is provided directly through AOSpine’s Research department and AO’s Clinical Investigation and Documentation unit. There are no other institutional subsidies, corporate affiliations, or funding sources supporting this work unless clearly documented and disclosed.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Alexander R. Vaccaro
    • 1
    Email author
  • Gregory D. Schroeder
    • 1
  • Christopher K. Kepler
    • 1
  • F. Cumhur Oner
    • 2
  • Luiz R. Vialle
    • 3
  • Frank Kandziora
    • 4
  • John D. Koerner
    • 1
  • Mark F. Kurd
    • 1
  • Max Reinhold
    • 5
  • Klaus J. Schnake
    • 6
  • Jens Chapman
    • 7
  • Bizhan Aarabi
    • 8
  • Michael G. Fehlings
    • 9
  • Marcel F. Dvorak
    • 10
  1. 1.The Rothman Institute at Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.University Medical CenterUtrechtThe Netherlands
  3. 3.Catholic UniversityCuritibaBrazil
  4. 4.Berufsgenossenschaftliche Unfallklinik FrankfurtCenter for Spinal Surgery and NeurotraumatologyFrankfurt/MainGermany
  5. 5.Klinikum Suedstadt RostockDepartment of Orthopaedic and Trauma SurgeryRostockGermany
  6. 6.Schön Klinik Nürnberg FürthCenter for Spinal TherapyFürthGermany
  7. 7.The Swedish Neuroscience InstituteSeattleUSA
  8. 8.University of Maryland School of MedicineBaltimoreUSA
  9. 9.University of TorontoTorontoCanada
  10. 10.University of British ColumbiaVancouverCanada

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