Decision-Making Process in Patients with Thoracolumbar and Lumbar Burst Fractures with Thoracolumbar Injury Severity and Classification Score Less than Four

STUDY DESIGN: Cross-sectional. PURPOSE: To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction. OVERVIEW OF LITERATURE: The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial. METHODS: This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not. RESULTS: In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed. CONCLUSIONS: The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.

Applicability of Thoracolumbar Injury Classification and Severity Score to Criteria of Korean Health Insurance Review and Assessment Service in Treatment Decision of Thoracolumbar Injury

OBJECTIVE: For improving the drawbacks of previous thoracolumbar spine trauma classification, the Spine Trauma Study Group was developed new classification, Thoracolumbar Injury Classification and Severity Score (TLICS). The simplicity of this scoring system makes it useful clinical application. However, considering criteria of Korean Health Insurance Review and Assessment Service (HIRA), the usefulness of TLICS system is still controversial in the treatment decision of thoracolumbar spine injury. METHODS: Total 100 patients, who admitted to our hospital due to acute traumatic thoracolumbar injury, were enrolled. In 45, surgical treatment was performed and surgical treatment was decided following the criteria of HIRA in all patients. With assessing of TLICS score and Denis's classification, the treatment guidelines of TLICS and Denis's classification were applied to the criteria of Korean HIRA. RESULTS: According to the Denis's three-column spine system, numbers of patients with 2 or 3 column injuries were 94. Only 45 of 94 patients (47.9%) with middle column injury fulfilled the criteria of HIRA. According to TLICS system, operation required fractures (score>4) were 31 and all patients except one fulfilled the criteria of HIRA. Conservative treatment required fractures (score<4) were 52 and borderline fracture (score=4) were 17. CONCLUSION: The TLICS system is very useful system for decision of surgical indication in acute traumatic thoracolumbar injury. However, the decision of treatment in TLICS score 4 should be carefully considered. Furthermore, definite criteria of posterior ligamentous complex (PLC) injury may be necessary because the differentiation of PLC injury between TLICS score 2 and 3 is very difficult.

Repeatability of TLICS scoring system used in the thoracolumbar spine injury / 中国基层医药

Objective To evaluate the thoracolumbar injury severity score [ thoracolumbar injury classifica-tion and severity score(TLICS)]and repeatability,and analyze its clinical significance in the treatment of injury of thoracolumbar.Methods The clinical and imaging data of our hospital (thoracolumbar X ray,CT examination,MRI examination) of intact thoracolumbar fractures in 90 patients were retrospectively analyzed ,respectively,TLICS score were made for their site of spinal injury morphology ,neural function and the posterior ligament complex three .Three months after reviewed ,TLICS was analyzed by using Cohen weighted kappa coefficient score .Its repeatability was ana-lyzed.Results According to the TLICS system ,spinal injury body ,nerve function and the integrity of the posterior ligamentous complex were evaluated , respectively, the repeatability coefficient of Kappa , the calculated total to 0.47 non operation group,operation group,the total score was 0.46,with a moderate consistency.The neural function evaluation of the highest high consistency ,consistency .No significant differences between the two groups of repetitive Kappa coefficient(statistical values =0.674 5,P>0.05).According to the TLICS system of statistical accuracy ,the diagnostic sensitivity,specificity ratios was 95.8%,86.4%,97.6%,respectively.Conclusion The reliability of TLICS system for thoracolumbar treatment and recovery is higher ,relative comprehensive evaluation ,which can effec-tively guide the clinical treatment .

Results of emergency operation for thoracolumbar vertebral column fixation by combined two incisions (front and behind) at Viet Duc Hospital from January 2005 to July 2006

Background: Vertebral column injuries are severe and common injuries in sugical emergencies. In vertebral column injuries, thoracolumbar location damages commonly because of its anatomic features. Objective: To describe clinical, subclinical features, and results of treatment in patients with vertebral column injuries who operated by combined two incisions; To discuss operative indications for thoracolumbar Burst fracture injuries. Subjects and method: The prospective study was performed in patients with thoracolumbar vertebral column injuries who operated at Viet Duc, from January to December 2005. All patients were evaluated about clinical, subclinical features, operative indications and techniques, and results. Results: The time from the accident to the operation was 24-72 hours (54.8%), over 6 days (25.8%), 3-6 days (12.9%), and 6-24 hours (6.5%). 13 of 31 cases damaged in L2, and 12 cases damaged in L1. The average time of operation was 5 hours 43 minutes (ranged 4 hours to 8 hours 30 minutes). The average transfused blood amount was one unit (ranged from 0 to 4 units). For complete paralysis, most patients recovered fully. For thoracolumbar Burst fracture injuries with incomplete paralysis, it should operate by front incision. In Burst fracture injuries with clear-off vertebra, no paralysis; it also should operate by front incision. Conclusions: The operation with combined two incisions (front and behind) was safe and effective technique for thoracolumbar vertebral column fixation.

Evaluation of pedicle screws applied in the affected vertebra for the treatment of thoracolumbar burst fracture / 中国矫形外科杂志

[Objective]To investigate curative effect for thoracolumbar burst fractures by the method of vertebral pedicle screw fixation applied in the with transpedicular bone graft,and consider its indications.[Method]Thirty cases of thoracolumbar burst fractures were treated by vertebral pedicle screw fixation combining transpedicular bone graft.Among them 22 were male and 8 were famale,age ranged 18-64.All of cases were single segment fractures.The average height of anterior border was 35% before the operation,the average of Cobb's angle was 26?,the percentage of midsagital diameter was 55%.According to Frankel's neurological function classification,preoperative neurological function was Grade A in 4 cases,B in 8,C in 5,D in 6,E in 7.[Result]All cases were followed up for 6 to 30 months.All patients' pain relieved distinctly,the average height anterior border was increased to 97%,the average of Cobb's angle was 3.5?,the percentage of midsagital diameter was 92% postoperatively,showing significant difference(P