Is there a Regional Difference in Morphology Interpretation of A3/A4 Fractures among Different Cultures?

Abstract

Introduction The AOSpine Thoracolumbar Spine Injury Classification System was recently published, but before establishing a treatment algorithm to accompany the classification, further investigation on the cause of current regional treatment variations is required. The objective of this study is to determine if the ability of a surgeon to correctly classify A3 (burst fractures with a single endplate involved) and A4 (burst fractures with both end plates involved) fractures were affected by either the region or the experience of the surgeon. Material and Methods A survey was sent to 100 AOSpine members from all six AO regions of the world (North America, South America, Europe, Africa, Asia, and the Middle East) that had no prior knowledge of the new AOSpine Thoracolumbar Spine Injury Classification System. Respondents were asked to classify 25 cases, including 6 thoracolumbar burst fractures (A3 or A4). The current analysis focuses on the effect of region and experience on surgeons' ability to properly classify these controversial fractures. Results All 100 surveyed surgeons completed the survey, and no significant regional variability in the ability to correctly classify burst fractures was identified ( p > 0.50). Further analysis demonstrated that no region predisposed surgeons increasing the severity of burst fractures. Similarly, experience did not affect surgeons' ability to correctly classify burst fracture ( p > 0.21). Conclusion Regional variation in the treatment of thoracolumbar burst fractures (A3 and A4) is not because of the differing radiographic interpretation of the fractures.