{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:46:21Z","timestamp":1792057581594,"version":"4.4.0"},"reference-count":75,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable \u201cU-type\u201d fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.5.spine211468","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T08:57:05Z","timestamp":1659085025000},"page":"914-926","source":"Crossref","is-referenced-by-count":17,"title":["Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review"],"prefix":"10.3171","volume":"37","author":[{"given":"Barry Ting Sheen","family":"Kweh","sequence":"first","affiliation":[{"name":"National Trauma Research Institute, Melbourne;"},{"name":"Department of Neurosurgery, The Alfred Hospital, Melbourne;"},{"name":"Department of Neurosurgery, Royal Melbourne Hospital, Parkville;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin W.","family":"Tee","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute, Melbourne;"},{"name":"Department of Neurosurgery, The Alfred Hospital, Melbourne;"},{"name":"Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. Cumhur","family":"Oner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University Medical Center Utrecht, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus J.","family":"Schnake","sequence":"additional","affiliation":[{"name":"Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen;"},{"name":"Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiliano N.","family":"Vialle","sequence":"additional","affiliation":[{"name":"Cajuru Hospital, Catholic University of Parana, Curitiba, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Kanziora","sequence":"additional","affiliation":[{"name":"Spinal Surgery and Neurotraumatology Centre, BG Trauma Clinic Frankfurt, Frankfurt am Main, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanmuganathan","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Spine Surgery, Ganga Hospital, Coimbatore, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Dvorak","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens R.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorin M.","family":"Benneker","sequence":"additional","affiliation":[{"name":"Sonnenhofspital Bern, University of Bern, Switzerland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Schroeder","sequence":"additional","affiliation":[{"name":"The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander R.","family":"Vaccaro","sequence":"additional","affiliation":[{"name":"The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Folia Morphol (Warsz)","first-page":"651","article-title":"Anatomy and clinical significance of sacral variations: a systematic review","volume":"78","author":"Nastoulis E","year":"2019","unstructured":"Nastoulis E, Karakasi MV, Pavlidis P, Thomaidis V, Fiska A. Anatomy and clinical significance of sacral variations: a systematic review. Folia Morphol (Warsz). 2019;78(4):651\u2013667.30949993"},{"issue":"1","key":"b2","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Sacral fractures","volume":"37","author":"Bydon M","year":"2014","unstructured":"Bydon M, Fredrickson V, De la Garza-Ramos R,  Sacral fractures. Neurosurg Focus. 2014;37(1):E12.24981900"},{"issue":"7","key":"b3","series-title":"Global Spine J","first-page":"609","article-title":"Sacral fractures and associated injuries","volume":"7","author":"Rodrigues-Pinto R","year":"2017","unstructured":"Rodrigues-Pinto R, Kurd MF, Schroeder GD,  Sacral fractures and associated injuries. 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