E1046. Demystifying Spine Trauma: Pictorial Review of AO Spine Injury Classifications for the Radiologist
  1. Iulian Dragusin; San Antonio Uniformed Services Health Education Consortium
  2. Douglas Byerly; San Antonio Uniformed Services Health Education Consortium
Spine trauma is a common cause of morbidity and mortality in the United States. The radiologist plays a key role in assisting the surgeon and clinical team in diagnosing the patient’s injuries allowing for appropriate management and treatment. Multiple classifications of spine trauma exist such as the Deni and Magerl thus resulting in possible confusions between radiologists, spine surgeons and patients regarding the nature of their spine injury. Standardized reporting in radiology has shown to be preferred by clinicians and patients and reporting systems such as BI-RADS and lumbar disc nomenclature have become widespread. A comprehensive classification system is provided by the international Switzerland based spine surgery organization “Arbeitsgemeinschaft für Osteosynthesefragen" (AO) Spine. The AO Spine foundation has developed systematic and clinically validated tools for classifying spine trauma in an effort to standardize optimal patient outcomes. The classifications are also used by surgeons to create surgical algorithm guidelines. AO Spine provides clinical reference cards that can assist the radiologist with spine injury classification and share a common language with spine surgeons.

Educational Goals / Teaching Points
In this exhibit we will review the AO Spine injury classifications with corresponding radiologic case examples and their correlates in the AO Spine injury clinical reference cards. After reviewing this exhibit, the reader will understand how to apply the alphanumeric injury designation for each zone (upper cervical, subaxial, thoracolumbar, and sacral) that can succinctly describe the location, type and severity of injury to the surgeon. The reader will also be able to apply the standard alphanumeric modifiers of injury features such as instability, that are vascular injury and soft tissue injury important to the patient’s care.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will review a spectrum of spine trauma. We discuss upper cervical injury, subaxial cervical injury, thoracolumbar injury and sacral injury classification with radiographic, CT, and MR pictorial examples and diagrammatic correlates. We will also briefly discuss the validation of AO spine injury classification and treatment of these injuries based on the classification.

Spine trauma is an important and common cause of disability and death. Standard classification and radiology reporting may assist spine surgeons and the clinical team in the timely diagnosis and treatment of patients, thereby decreasing morbidity and mortality. Even if the AO classification system is not implemented at one’s facility, the radiologist should be familiar with the AO Spine injury classification system as a standard international tool for describing spine trauma to facilitate discussion with other clinicians/subspecialties who do use it.