AO Spine Injury Classification System; Application on Patients with Traumatic Thoracolumbar Spine Fractures Referred to Benha University Hospitals

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 6^th 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.