Narrative ReviewSurgical Management of Thoracolumbar Burst Fractures Surgical Decision-making Using the AOSpine Thoracolumbar Injury Classification Score and Thoracolumbar Injury Classification and Severity ScoreMorrissey, Patrick B. MD*; Shafi, Karim A. MS†; Wagner, Scott C. MD‡; Butler, Joseph S. MD, FRCS§; Kaye, Ian D. MD∥; Sebastian, Arjun S. MD¶; Schroeder, Gregory D. MD∥; Kepler, Christopher K. MD, MBA∥; Aarabi, Bizhan MD#; Oner, Fetullah C. MD, PhD**; Vaccaro, Alexander R. MD, MBA, PhD∥Author Information *Naval Medical Center San Diego, San Diego, CA †Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA ‡Walter Reed National Military Medical Center, Bethesda, MD §Mater Misericordiae University Hospital, Dublin, Ireland ∥Rothman Institute, Philadelphia, PA ¶Mayo Clinic, Rochester, MN #University of Maryland School of Medicine, Baltimore, MD **Department of Orthopaedic Spine Surgery, University Medical Center, Utrecht, The Netherlands Dr Schroeder has received funds to travel from AOSpine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AOSpine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest. Reprints: Patrick B. Morrissey, MD, Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134 (e-mail: [email protected]). Clinical Spine Surgery: February 2021 - Volume 34 - Issue 1 - p 4-13 doi: 10.1097/BSD.0000000000001038 Buy Metrics Abstract The management of thoracolumbar burst fractures is controversial with no universally accepted treatment algorithm. Several classification and scoring systems have been developed to assist in surgical decision-making. The most widely accepted are the Thoracolumbar Injury Classification and Severity Score (TLICS) and AOSpine Thoracolumbar Injury Classification Score (TL AOSIS) with both systems designed to provide a simple objective scoring criteria to guide the surgical or nonsurgical management of complex injury patterns. When used in the evaluation and treatment of thoracolumbar burst fractures, both of these systems result in safe and consistent patient care. However, there are important differences between the 2 systems, specifically in the evaluation of the complete burst fractures (AOSIS A4) and patients with transient neurological deficits (AOSIS N1). In these circumstances, the AOSpine system may more accurately capture and characterize injury severity, providing the most refined guidance for optimal treatment. With respect to surgical approach, these systems provide a framework for decision-making based on patient neurology and the status of the posterior tension band. Here we propose an operative treatment algorithm based on these fracture characteristics as well as the level of injury. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.