In 2016 the AOSpine published an algorithm for determining the need for surgical intervention on injuries to the thoracolumbar spine injuries (37).
|Type of Injury||Subtype Injury||# Points Assigned|
|Type A – Compression Fx|
|A0 – Minimal Injury
(e.g. transverse process fx)
|A1 – Compression Fx||1|
|A2 – Pincer Compression Fx||2|
|A3 – Incomplete Burst Fx
(only involves one end-plate)
|A4 – Complete Burst Fx||5|
|Type B – Tension Band Injury|
|B1 – Osseous Disruption Tension Band||5|
|B2 – Posterior Tension Band Injury
(including ligamentous injury)
|B3 – Anterior Tension Band Injury||7|
|Type C – Translational Injury||8|
|N1 – None, neurologically intact||0|
|N2 – Resolved, transient symptoms||1|
|N3 – Persisting radicular symptoms||2|
|N4 – Incomplete spinal cord injury||4|
|N5 – Complete spinal cord injury||4|
|N6 – Neurological exam unattainable||3|
|Patient Specific Modifiers|
- Nonsurgical management: Recommended when the sum of all categories is 0–3.
- Surgical management: Recommended when the sum of all categories is ≥5.
- Consideration of either intervention: Necessary when the total equals 4.
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