AO Spine Sacral Injury

Classification System
Type A Type B Type C
Lower Sacrococcygeal Posterior Pelvic Injuries Spino-Pelvic Injuries
Injuries

A1 Ccompression
occygeal or
vs
ligamentous avulsion
B1 Central Fracture­—
involves spinal canal C0 Nsacral
ondisplaced

variant
U-type

fractures

B2 Tdoes
ransalar Fracture—
not involve
foramina or spinal
canal

A2 Ntransverse
on-displaced
fractures
C1 Swithout
acral U-type variant
posterior
pelvic instability
below the S-I joint

B3 TFracture—involves
ransforaminal

foramina but not

C2 BType
ilateral complete
B injuries
without transverse
spinal canal fracture

A3 Dfractures
isplaced transverse

S-I joint
below the

C3 Displaced U-type
sacral fracture

Contact: research@aospine.org Further information: www.aospine.org/classification

 AO Spine Sacral Injury
Classification System

Sacral Fractures–Overview
Hierarchical system progressing from least to most unstable

Type A Lower Sacrococcygeal Injuries

No impact on posterior pelvic or spino-pelvic instability
Type B Posterior Pelvic Injuries
Primary impact is on posterior pelvic stability
Type C Spino-Pelvic Injuries
Spino-pelvic instability

Neurology Modifiers
Type Neurological Type Description

N0 Neurology intact
M1 Soft tissue injury
N1 Transient neurologic deficit

N2 Radicular symptoms M2 Metabolic bone disease

Incomplete spinal cord injury or
N3
any degree of cauda equina injury

N4* Complete spinal cord injury M3 Anterior pelvic ring injury

NX Cannot be examined
M4 Sacroiliac joint injury
+ Continued spinal cord compression

*The AO Spine Injury Classification Systems follow a universal neurological system for the whole spine.
For the sacrum, N4 is theoretically and anatomically impossible.

Classification Nomenclature
Transforaminal fracture (B3) high energy injury associated with
transient neurological deficit (N1) and anterior pelvic ring injury (M3)

Primary injury
B3; N1, M3 Neurologic status
and modifiers

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