RESUMO
STUDY DESIGN: Retrospective review of patient cohort. OBJECTIVE: Our goal was to assess the validity of the Thoracolumbar Injury Classification and Severity (TLICS) score system by comparing the TLICS system to prior management of thoracolumbar injuries at our institution between January 1, 2006 to March 31, 2011. SUMMARY OF BACKGROUND DATA: TLICS was introduced in 2005 to classify and assign treatment recommendations for injuries based on 3 axes: mechanism of injury, integrity of the posterior ligamentous complex, and neurological status. METHODS: We retrospectively obtained and analyzed patient data regarding thoracolumbar junction injuries at a major academic medical center servicing level I trauma. In addition, we compared the American Spinal Injury Association (ASIA) class at time of injury to last follow-up to determine if there was any change in neurological status after intervention. We also compared sex, injury severity score (ISS), length of hospitalization, and age between nonoperatively and operatively treated patients. RESULTS: Included in our study were 201 patients (70% male and 30% female). We found the TLICS system agreed with prior thoracolumbar junction injury management at our institution 98% of the time in nonoperatively treated patients and 78% of the time in operatively treated patients. Age, sex, and ISS were not statistically significant factors in patients who were treated operatively versus nonoperatively, however, there was a trend towards higher ISS in operatively treated patients. Average TLICS score between nonoperative and operative groups was 1.56 and 4.8, respectively, and was a statistically significant difference. There was no statistically significant difference in ASIA class improvement between operative and nonoperative treatment, however, this is likely because of having only 20 patients in this subcohort. Of note, about 50% of the 17 operatively treated patients had improvement in ASIA class. CONCLUSIONS: Our data suggest that TLICS is a valuable tool in a spine surgeon's armamentarium in treating thoracolumbar junction injuries. Some surgeons might be more likely to operate on thoracolumbar junction injuries that should be treated nonoperatively according to the TLICS score. As with all classification schemes, the TLICS system should be used in conjunction with sound clinical judgment.
Assuntos
Vértebras Lombares/lesões , Traumatismos da Coluna Vertebral/classificação , Vértebras Torácicas/lesões , Centros Médicos Acadêmicos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Humanos , Escala de Gravidade do Ferimento , Ligamentos/patologia , Longevidade , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Traumatismos da Coluna Vertebral/patologia , Traumatismos da Coluna Vertebral/cirurgia , Vértebras Torácicas/patologia , Resultado do TratamentoAssuntos
Hematoma Epidural Espinal/etiologia , Hematoma Epidural Espinal/cirurgia , Laminectomia/métodos , Paraplegia/cirurgia , Ferimentos e Lesões/complicações , Vértebras Cervicais/patologia , Criança , Seguimentos , Hematoma Epidural Espinal/diagnóstico , Humanos , Escala de Gravidade do Ferimento , Imageamento por Ressonância Magnética/métodos , Masculino , Paraplegia/diagnóstico , Paraplegia/etiologia , Cuidados Pós-Operatórios/reabilitação , Medição de Risco , Índice de Gravidade de Doença , Vértebras Torácicas/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The educational objectives of this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging of diffuse idiopathic skeletal hyperostosis (DISH), with emphasis on acute spinal fractures. CONCLUSION: Understanding the pathomechanics of the fractures in the ankylosed spine is important in the differentiation of the acute spinal fractures in DISH and ankylosing spondylitis. This article emphasizes the imaging features of spinal DISH and acute spinal fractures in DISH, distinguishing them specifically from those in ankylosing spondylitis.
Assuntos
Hiperostose Esquelética Difusa Idiopática/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Espondilite Anquilosante/diagnóstico , Doença Aguda , Diagnóstico Diferencial , Humanos , Hiperostose Esquelética Difusa Idiopática/fisiopatologia , Imageamento por Ressonância Magnética , Fraturas da Coluna Vertebral/fisiopatologia , Espondilite Anquilosante/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging of diffuse idiopathic skeletal hyperostosis (DISH).