• Miguel Pishnamaz, Inez Curfs, Stephan Balosu, Paul Willems, Wouter van Hemert, Hans-Christoph Pape, and Philipp Kobbe.
• *Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany†Department of Orthopaedics, Spine Centre, University of Maastricht Medical Center, Maastricht, The Netherlands‡Department of Orthopaedic Surgery and Traumatology, Atrium Medical Centre Heerlen, Heerlen, The Netherlands.
• Spine. 2015 Nov 1; 40 (22): 1749-56.

Study DesignWeb-based multicenter study.ObjectiveThe aim of the study was to assess and compare the management strategy for traumatic thoracolumbar fractures between German and Dutch spine surgeons.Summary Of Background DataTo date, there is no evidence-based treatment algorithm for thoracolumbar spine fractures, thereby an international controversy concerning optimal treatment exists.MethodsIn this web-based multicenter study (www.spine.hostei.com), computed tomography scans of traumatic thoracolumbar fractures (T12-L2) were evaluated by German and Dutch spine surgeons. Supplementary case-specific information such as age, sex, height, weight, neurological status, and injury mechanism were provided.By using a questionnaire, fractures were classified according to the AO-Magerl Classification, followed by 6 questions concerning the treatment algorithm. Data were analyzed using SPSS (Version 21, 76, Chicago, IL). The interobserver agreement was determined by using Cohen κ. Statistical significance was defined as P < 0.05.ResultsTwelve surgeons (6 per country) evaluated each 91 cases. The fractures were classified as AO Type A in 82% (898 votes), Type B in 14% (150 votes), and Type C in 4% (44 votes). No significant difference concerning the AO Classification between German and Dutch spine surgeons was found. Overall German spine surgeons had a lower threshold concerning the indication for surgical treatment (Ger 87% vs. NL 30%; P < 0.05). There was a consensus about operative stabilization of AO Type B and C injuries and injuries with neurologic deficit, whereas a discrepancy in the therapeutic algorithm for AO Type A fractures was observed. This difference was most pronounced regarding the indication for posterior (Ger 96.6%; NL 41.2%; P < 0.05) and circumferential stabilization (Ger 53.4%; NL 0%; P < 0.05) for burst fractures.ConclusionThere is a consensus to stabilize AO Type B and C fractures, whereas country-specific differences in the treatment of Type A fractures, especially in case of burst fractures, occur. Prospective, controlled multicenter outcome studies may provide more evidence in optimal treatment for thoracolumbar fractures.Level Of Evidence2.

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