# AO Spine TL — AO Spine thoracolumbar injury classification and TL AOSIS

> Per-injury thoracolumbar-trauma framework that reports the exact A0-A4, B1-B3 or C morphology, clinical neurologic status N0-N4/NX, continued cord compression when present, and M1/M2 modifiers. TL AOSIS sums morphology, neurology and M1; thresholds of 3 or less, 4-5 and 6 or more are guidance bands, not a letter-only treatment order or calibrated prognosis.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** AO Spine · **Versão:** 2013 classification; 2016 TL AOSIS and treatment-guidance algorithm; official pocket-card terminology current · **Ano:** 2013

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: score
- Modalidade: CT, MRI, Clinical
- Fonte primária: Vaccaro AR, Oner C, Kepler CK, et al.. AOSpine thoracolumbar spine injury classification system (2013) — https://doi.org/10.1097/BRS.0b013e3182a8a381
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Classify exact morphology first, add the clinical neurologic code and modifiers, show TL AOSIS arithmetic, and preserve the difference between a consensus guidance band and an individual treatment decision.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| A | Type A, compression | Type A is a compression injury without established tension-band failure or translation. Resolve the exact subtype: A0 minor nonstructural injury; A1 wedge/impaction without posterior-wall involvement; A2 split/pincer involving both endplates without the posterior wall; A3 incomplete burst involving the posterior wall and one endplate; or A4 complete burst involving the posterior wall and both endplates. | Do not manage from the parent A label. Calculate TL AOSIS from the exact morphology (A0=0, A1=1, A2=2, A3=3, A4=5), the clinical N code and M1. Totals <=3 support an initial nonoperative trial, 4-5 allow either pathway, and >=6 support surgery; apply the band as consensus guidance with patient and injury context. | A0-A4 is an ordered morphology hierarchy, but neither the A letter nor TL AOSIS is a calibrated probability of neurologic decline, mortality, kyphosis, pain or treatment failure. Posterior-wall involvement distinguishes burst morphology; canal narrowing cannot substitute for the clinical neurologic examination. | AO Spine Surgery Reference flow chart and sections A0-A4; Kepler et al. Global Spine J 2016, DOI 10.1055/s-0035-1563610, Tables 3-4; Vaccaro et al. Eur Spine J 2016, DOI 10.1007/s00586-015-3982-2, abstract treatment bands. | ✓ |
| B | Type B, tension band | Type B is tension-band failure without translation. Resolve B1, a pure monosegmental transosseous posterior disruption (Chance); B2, posterior osseoligamentous or soft-tissue/bony tension-band disruption; or B3, anterior tension-band failure in hyperextension, often in an ankylotic spine. Record the injured motion segment and any associated A subtype. | Use the subtype before applying TL AOSIS: B1 contributes 5 points and is in the 4-5 either-pathway band when N0 and M1 are absent, whereas B2=6 and B3=7 already enter the surgical-guidance band. Add N and M1, preserve M2 context, and do not treat the parent B label as an automatic operation. | B injuries represent tension-band disruption and greater perceived injury severity, but the score encodes international surgeon consensus rather than an individual adverse-event probability. B1, B2 and B3 are not equivalent, and M2 factors such as ankylosing disease can materially change risk and care despite adding zero points. | AO Spine Surgery Reference sections B1-B3, associated-A nomenclature and modifiers; Kepler et al. Global Spine J 2016, DOI 10.1055/s-0035-1563610, Tables 3-4; Vaccaro et al. Eur Spine J 2016, DOI 10.1007/s00586-015-3982-2, treatment algorithm. | ✓ |
| C | Type C, translation | Type C is displacement, dislocation or translation in any plane with separation of the anterior and posterior components of a motion segment. It takes precedence over A or B as the principal morphology, while the involved level and associated vertebral-body A subtype or tension-band injury must still be recorded. | Type C contributes 8 morphology points, so it exceeds the TL AOSIS surgical-intervention threshold before neurologic or M1 points are added. Treat this as a prompt for urgent spine-specialist assessment and stabilization planning, not an autonomous order that overrides resuscitation, contraindications, goals of care, polytrauma priorities or M2 context. | C is the highest morphology tier and is translationally unstable, but it does not quantify a patient's probability of paralysis, mortality or surgical outcome. Report displacement, canal compromise, clinical neurology, continued cord compression and associated injuries separately instead of using C as a complete prognosis. | AO Spine Surgery Reference sections Type C and nomenclature; Kepler et al. Global Spine J 2016, DOI 10.1055/s-0035-1563610, Table 3 (C=8) and Table 4; Vaccaro et al. Eur Spine J 2016, DOI 10.1007/s00586-015-3982-2, >5 surgical-guidance threshold. | ✓ |

### Citações por categoria
- **A**: Vaccaro AR, Schroeder GD, Kepler CK, et al.. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system (2016) — https://pubmed.ncbi.nlm.nih.gov/25953527/ · AO Spine Surgery Reference flow chart and sections A0-A4; Kepler et al. Global Spine J 2016, DOI 10.1055/s-0035-1563610, Tables 3-4; Vaccaro et al. Eur Spine J 2016, DOI 10.1007/s00586-015-3982-2, abstract treatment bands.
- **B**: Vaccaro AR, Schroeder GD, Kepler CK, et al.. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system (2016) — https://pubmed.ncbi.nlm.nih.gov/25953527/ · AO Spine Surgery Reference sections B1-B3, associated-A nomenclature and modifiers; Kepler et al. Global Spine J 2016, DOI 10.1055/s-0035-1563610, Tables 3-4; Vaccaro et al. Eur Spine J 2016, DOI 10.1007/s00586-015-3982-2, treatment algorithm.
- **C**: Vaccaro AR, Schroeder GD, Kepler CK, et al.. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system (2016) — https://pubmed.ncbi.nlm.nih.gov/25953527/ · AO Spine Surgery Reference sections Type C and nomenclature; Kepler et al. Global Spine J 2016, DOI 10.1055/s-0035-1563610, Table 3 (C=8) and Table 4; Vaccaro et al. Eur Spine J 2016, DOI 10.1007/s00586-015-3982-2, >5 surgical-guidance threshold.

## Referências cruzadas
- _fronteira compartilhada_ → [TLICS — Thoracolumbar Injury Classification and Severity score](https://radcommons.laudos.ai/systems/tlics.md) — AO Spine TL and TLICS describe overlapping thoracolumbar trauma but use different morphology taxonomies, ligament treatment and thresholds. Preserve raw CT, MRI and clinical-examination facts and calculate each framework independently.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-12 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-11 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-30 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2019-01-01 | revised | The CNS evidence-based guideline supported classification for communication but found insufficient evidence for a universal severity score to determine all treatment or predict outcomes. This is a use boundary, not a new AO category set. | confirmed |
| 2016-04-01 | revised | The AO Spine surgical-algorithm study defined the initial guidance bands: 3 or less for a nonoperative trial, 4-5 for either pathway, and more than 5 for surgical intervention. | confirmed |
| 2015-09-29 | revised | Kepler and colleagues published the companion TL AOSIS point table for A0-A4, B1-B3, C, N0-N4/NX and M1/M2. This added a score without changing the morphology labels. | confirmed |
| 2013-11-01 | published | AOSpine thoracolumbar classification published. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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