Thoracolumbar Injury Classification Systems: The Importance of Concepts and Language in the Move Toward Standardization

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2023-03, Vol.48 (6), p.436-443
• Main Authors: Lightsey IV, Harry M., Giberson-Chen, Carew C., Crawford, Alexander M., Striano, Brendan M., Harris, Mitchel B., Bono, Christopher M., Simpson, Andrew K., Schoenfeld, Andrew J.
• Format: Article
• Language: English
• Subjects: Humans; Language; Lumbar Vertebrae - surgery; Reference Standards; Reproducibility of Results; Spinal Injuries; Thoracic Vertebrae - surgery; Wounds, Nonpenetrating
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0000000000004578

Narrative review. To describe the evolution of acute traumatic thoracolumbar (TL) injury classification systems; to promote standardization of concepts and vocabulary with respect to TL injuries. Over the past century, numerous TL classification systems have been proposed and implemented, each influenced by the thought, imaging modalities, and surgical techniques available at the time. While much progress has been made in our understanding and management of these injuries, concepts, and terms are often intermixed, leading to potential confusion and miscommunication. We present a narrative review of the current state of the literature regarding classification systems for TL trauma. The evolution of TL classification systems has broadly been characterized by a transition away from descriptive categorizations of fracture patterns to schema incorporating morphology, stability, and neurological function. In addition to these features, more recent systems have demonstrated the importance of predictive/prognostic capability, reliability, validity, and generalizability. The Arbeitsgemeinschaft fur Osteosynthesenfragen Spine Thoracolumbar Injury Classification System/Thoracolumbar Arbeitsgemeinschaft fur Osteosynthesenfragen Spine Injury Score represents the most modern and recently updated system, retiring past concepts and terminology in favor of clear, internationally agreed upon descriptors. Advancements in our understanding of blunt TL trauma injuries have led to changes in management. Such advances are reflected in modern, dedicated classification systems. Over time, various key factors have been acknowledged and incorporated. In an effort to promote standardization of thought and language, past ideas and terminology should be retired.