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Background: The purpose of this study was to determine whether the new AOSpine thoracolumbar spine injury classification system is reliable and reproducible when applied to the pediatric population., Methods: Nine POSNA (Pediatric Orthopaedic Society of North America) member surgeons were sent educational videos and schematic papers describing the AOSpine thoracolumbar spine injury classification system. The material also contained magnetic resonance imaging and computed tomography imaging of 25 pediatric patients with thoracolumbar spine injuries organized into cases to review and classify. The evaluators classified injuries into 3 primary categories: A, B, and C. Interobserver reliability was assessed for the initial reading by Fleiss kappa coefficient (kF) along with 95% confidence interval (CI). For A and B type injuries, subclassification was conducted including A0 to A4 and B1 to B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff alpha (αk) along with bootstrapped 95% CI. Imaging was reviewed a second time by all evaluators ~1 month later. All imaging was blinded and randomized. Intraobserver reproducibility was assessed for the primary classifications using Fleiss kappa and subclassification reproducibility was assessed by Krippendorff alpha (αk) along with 95% CI. Interpretations for reliability estimates were based on Landis and Koch (1977): 0 to 0.2, slight; 0.2 to 0.4, fair; 0.4 to 0.6, moderate; 0.6 to 0.8, substantial; and >0.8, almost perfect agreement., Results: Twenty-five cases were read for a total of 225 initial and 225 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF=0.82; CI, 0.77-0.87) across all raters. Subclassification reliability was substantial (αK=0.79; CI, 0.62-0.90). Adjusted intraobserver reproducibility was almost perfect (kF=0.81; CI, 0.71-0.90) for both primary classifications and for subclassifications (αk=0.81; CI, 0.73-0.86)., Conclusions: The reliability for the AOSpine thoracolumbar spine injury slassification System was high amongst POSNA surgeons when applied to pediatric patients. Given a lack of a uniform classification in the pediatric population, the AOSpine thoracolumbar spine injury classification system has the potential to be used as the first universal spine fracture classification in children., Level of Evidence: Level III.

Background: Surgical options for the management of idiopathic early onset scoliosis (EOS) have increased over the past decade, perhaps surpassing traditional nonoperative methods. We sought to assess current treatment preferences in the management of EOS among pediatric orthopaedic surgeons. We hypothesized that practitioner access to casting tables and halo traction would be significantly associated with treatment choices., Methods: A web-based survey was distributed to the members of the Pediatric Orthopaedic Society of North America. Information with regard to practice type, access to casting tables and halo traction, and management of patients with EOS was obtained. Clinical vignettes were used to assess current physician preferences in the treatment of EOS, including the use of bracing, casting, halo-gravity traction, fusionless spine techniques, definitive fusion, and chest wall devices., Results: Members of Pediatric Orthopaedic Society of North America (19.8%) completed the survey with the vast majority of respondents (93.8%) treating children with EOS. Sixty-six percent of respondents had access to a casting table and 77% reported access to halo-gravity traction. Access to casting tables and access to halo-gravity traction was associated with the use of casting and traction (P<0.0001). Equal numbers of surgeons currently use casting (62%) and growing spine techniques (64.1%). Chest wall expansion was offered as a treatment option by 39.1% of surgeons, and 27% of surgeons reported the use of halo-gravity traction. Ninety-three percent of respondents chose nonoperative management of a 2-year-old child with a 50° progressive scoliosis. In contrast, 63% of surgeons would offer surgery as the initial management to a 5-year-old child with a progressive 70° idiopathic scoliosis., Conclusions: The majority of respondents had access to halo traction and casting tables at their hospitals. There was a statistically significant association between access to equipment and use of casting and halo traction. Nonoperative management was the preferred treatment option in the very young (2 year-old). Two-thirds of surgeons report initial surgical management of the 5-year-old child with a large idiopathic curve.