AOSpine—Spine Trauma Classification System: The Value of Modifiers: A Narrative Review With Commentary on Evolving Descriptive Principles

Study Design: Narrative review. Objectives: To describe the current AOSpine Trauma Classification system for spinal trauma and highlight the value of patient-specific modifiers for facilitating communication and nuances in treatment. Methods: The classification for spine trauma previously developed by The AOSpine Knowledge Forum is reviewed and the importance of case modifiers in this system is discussed. Results: A successful classification system facilitates communication and agreement between physicians while also determining injury severity and provides guidance on prognosis and treatment. As each injury may be unique among different patients, the importance of considering patient-specific characteristics is highlighted in this review. In the current AOSpine Trauma Classification, the spinal column is divided into 4 regions: the upper cervical spine (C0-C2), subaxial cervical spine (C3-C7), thoracolumbar spine (T1-L5), and the sacral spine (S1-S5, including coccyx). Each region is classified according to a hierarchical system with increasing levels of injury or instability and represents the morphology of the injury, neurologic status, and clinical modifiers. Specifically, these clinical modifiers are denoted starting with M followed by a number. They describe unique conditions that may change treatment approach such as the presence of significant soft tissue damage, uncertainty about posterior tension band injury, or the presence of a critical disc herniation in a cervical bilateral facet dislocation. These characteristics are described in detail for each spinal region. Conclusions: Patient-specific modifiers in the AOSpine Trauma Classification highlight unique clinical characteristics for each injury and facilitate communication and treatment between surgeons

Functional Outcomes after Lumbar Fusion in Opioid-Tolerant Patients

Introduction: Prolonged opioid use after lumbar fusion surgery is implicated with increased hospital readmissions, higher postoperative pain scores, and longer return to work time. There are several non-modifiable risk factors for postoperative opioid use including socioeconomic status and gender. The purpose of this study was to determine the effects of opioid-tolerance on PROMs and to determine risk factors for prolonged opioid use after lumbar spine surgery. Method: Using retrospective cohort analysis, patients who underwent lumbar spinal fusion at TJUH were identified and determined to be either opioid-naïve or opioid-tolerant using the Pennsylvania PDMP. Outcomes included number of opioid tablets consumed, duration of time using opioids, and patient-reported outcome measures (ODI, PCS-12, MCS-12, VAS Back, VAS Leg). Univariate and multivariate analysis were used to compare outcomes between the two groups. Logistic regression was used to determine independent predictors for prolonged opioid use which was defined as greater than one postoperative opioid prescription script filled. Results: A total of 260 patients were included in the final cohort, of which, 138 were opioid-tolerant and 122 were opioid naïve. Opioid-tolerant patients showed decreased improvement in PROMs compared to the opioid-naïve patients (p=0.043). The number of preoperative pills prescribed was a significant predictor for prolonged opioid use after lumbar fusion. Conclusion: The number of pills prescribed preoperatively was found to be a predictor for prolonged opioid use after lumbar fusion surgery. Overall, our results demonstrated that naïve patients have improved health-related quality of life outcome scores compared to opioid-tolerant patients after lumbar fusion