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AOSpine KF Trauma –
Systematically bringing the world on the same page
The AOSpine Knowledge Forum (KF) Trauma has been developing basic AO principles, classifications, severity scoring systems, treatment algorithms and outcome measures from the moment it was founded. The simple algorithmic approach allows clinicians to understand the basic trauma mechanisms. And because the systems are repeatable and coherent, AOSpine is putting people from all countries on the same page.
"I never thought back then we could accomplish as much as we already have", says Alex Vaccaro. "Before the KFs, we were never really exposed to opinion leaders from different countries, with different perspectives. It stimulated us to ask important topical questions and opened up opportunities we never thought existed." Vaccaro co-chaired the KF Trauma and Spinal Cord Injury (SCI) in its early days, which was originally launched as "The KFs stimulated us to ask important topical questions and opened up opportunities we never thought existed."one. A growing number of studies led to setting up two groups, allowing both to excel in their key focus areas.
To Vaccaro, the KFs are the purest kind of study groups, where physicians decide what is best for research without involvement from companies. "We are looking at topics such as the management of trauma in osteoporosis, and the use of artificial intelligence to understand the classification of fractures; topics that industry might not have an interest in and would not support."
Towards a universal language
The most impactful project of KF Trauma has been the development of the AOSpine Spine Trauma Classification System and the Injury Severity Score. The final part of the system, the occipital cervical injuries, will be launched at the Global Spine Congress in Singapore, "Earlier, you would call a fracture whatever you liked. With the AO system you immediately know what you are talking about."in May 2018. "We are systematically using the same approach to cover the entire spinal column and to understand these injuries", Chairperson Cumhur Öner explains. A reiterative methodology involves several work intensive and lengthy assessment cycles. Once the expert group agrees on a final version, a verification is done in the AOSpine community. "We included hundreds of people from all over the world, and sent them cases to classify", Öner explains. "The community was invaluable, it confirmed our system is reliable and useful."
The AOSpine Spine Trauma Classification System is becoming the universal language for trauma, replacing nonspecific descriptors from before. "Earlier, you would call a fracture whatever you liked", Vaccaro says. "With the AO system you immediately know what you are talking about."
KF Trauma's position is strong beyond classifications and the audience of spine surgeons. Recently the group published a Focus Issue, reaching out to the entire trauma community with the latest up to date knowledge, and laying out remining knowledge gaps. "We have the advantage of being the only global spine trauma study group, there are no rival groups", Öner points out adding another advantage to their work, the intensive cooperation on overlapping topics with its AO sister groups, KF SCI and KF Tumor.
Painstakingly exploring grey areas
The biggest challenge ahead is the wide treatment variations. There is still a big grey area where guidelines are lacking. "Same injuries are treated with a kind of a benign neglect in some areas, and very aggressively in others, and everyone is equally confirmed their philosophy is the right one", Öner says. "We don't yet have the means to understand what "Same injuries are treated with a benign neglect in some areas, and very aggressively in others; everyone equally confirmed their philosophy is the right one. We don't yet have the means to understand what is the best way."is the best way." An on-going parallel cohort study on AOSpine A3/A4 fractures will bring clarity to this in a couple of years. Steering Committee member Lorin Benneker reminds these guidelines are not only important for the patients, but have a wider economic implication. "To get funds back, we must provide the insurers with good clinical data."
Most existing outcome instruments are not suitable for spine trauma patients; they are either too generic or were created for a different patient population. "We wanted a system that was condition-specific for spine trauma, and to measure outcomes separately from patient and surgeon perspectives. In the end, this will be the society's perspective", Öner says, explaining the background for developing the Patient and Clinician Reported Outcome Spinal Trauma (AOSpine PROST and CROST).
AOSpine PROST was realized globally with 10 centers, and it is currently being validated in English and Dutch. A German version will be produced next. The study revealed that Guidelines are not only important for patients and clinicians; they have a wider economic and social implication.patients' expectations are essentially different from what specialists had thought. Conventionally, spine surgeons had used systems developed for lower back pain patients, where the most important item is pain. "Most surgeons thought pain was the most important measure. But for our patients, it is not at all so!" Öner says. "If you break something, you understand that it hurts, which makes the pain more acceptable. These are not chronic patients; getting back to their normal life, recovering physical functions, returning to work, that is the most important thing for them."
Going the extra mile
The KF Trauma Steering Committee is progressing from a group of well-published opinion leaders initiating research, to increasingly involving others in studies. Öner believes the way forward is a balanced geographic distribution and onboarding young surgeons, the global opinion leaders of tomorrow. Recently Emiliano Vialle from Curitiba, "The Knowledge Forums are the crown of the AO!"Brazil, and Lorin Benneker, from Bern, Switzerland, were invited to the Steering Committee. "It was easy to accept. The KFs are the crown of the AO", Benneker laughs with open admiration for 'the old guys'. He sees them very settled, wanting to bring research to a higher level. "It's not about personal gain. Every member wants to accomplish something in their limited time. That's the fuel that keeps AO on the top, what makes AO so successful. And the strong support from the organization allows people to focus on the research and go the extra mile."
Öner encourages the wider AOSpine community to get involved in studies. "It is stimulating and makes you think of these issues." He reminds that trauma was always a "Artificial intelligence will be the next big focus area. If we manage to transfer the understanding to the 21st century, that is going to be a success!"good school for understanding and developing basic concepts, often directly applicable in other pathologies.
In Vaccaro's vision, every surgeon throughout the world, regardless of financial status, could use work products of AOSpine to improve patient care. "If we really get artificial intelligence working, you could for example download a free app. A patient comes in, you put the app up, see the radiographs, and immediately you get the recommended treatment, country-specifically, understanding the available resources. That would move the needle in terms of improving the quality of life for people from around the world." Such systematic approaches to trauma and their impact on patient care are the essence of AO also for Öner. "Artificial intelligence will be the next big focus area. If we manage to transfer the understanding to the 21st century, that is going to be a success!"
This article is part of a series on the AOSpine Knowledge Forums. Previous stories of the Knowledge Forums were published in AOSpine Newsletter Issues 11-14 2017. Upcoming issues will showcase more KFs and their most important study projects.
Newsletter 15 | March 2018
Newsletter 15 March 2018
MEET THE AOSPINE MEMBERS