Confusion regarding mechanisms of injury in the setting of thoracolumbar spinal trauma: a survey of The Spine Trauma Study Group (STSG)

The Spine Trauma Study Group (STSG) developed the thoracolumbar injury severity score to direct the management of thoracolumbar spine injuries. The original system is based on 3 variables: the mechanism of injury as determined by imaging studies, the integrity of the posterior ligamentous complex, and the neurologic status of the patient. Considerable controversy exists among treating physicians in classifying injury mechanisms. The purpose of this study was to survey the STSG on case examples related to the mechanism of thoracolumbar injury. A 2-question survey regarding thoracolumbar injury mechanisms and scoring was distributed to members of the STSG. A total of 27 STSG members completed surveys on defining and scoring thoracolumbar injury mechanisms. Data from these completed surveys were analyzed using a 2-tailed Fisher exact test on a chi2 contingency table. Sixty-seven percent of physicians preferred a definition incorporating posterior ligamentous complex disruption without posterior vertebral body retropulsion over the location of the axis of rotation in differentiating flexion-distraction from advanced stage flexion-compression injuries, representing a statistically significant difference (P=0.0285). There was no statistical consensus on the scoring emphasizing a primary and secondary mechanism of injury in complex injury patterns. Despite the statistical consensus to 1 survey question, there seems to be no dominating opinion on distinguishing thoracolumbar injury mechanisms. Perhaps identifying objective findings on imaging studies and clinical examination in place of guessing injury mechanisms may allow for a more reliable and valid thoracolumbar injury classification system.