Evaluation of the Thoracolumbar Injury Classification System (TLICS) in 458 Consecutively Treated PatientsKeywords: grading system, spinal cord injury, lumbar spine, trauma, thoracic spineInteractive Manuscript
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What is the background behind your study?
The Thoraco-Lumbar Injury Classification System (TLICS) system was
developed to improve injury classification and guide surgical
decision-making.
What is the purpose of your study?
Our purpose was to validate this scoring system.
Describe your patient group.
A retrospective analysis of 458 consecutive patients treated for thoracolumbar spine trauma from 2000 to 2010 at a single, tertiary medical center. 310 patients (67.6%) were treated conservatively (Group 1) and 148 patients (32.3%) were surgically (Group 2) treated. All patients in Group 1 were ASIA E, except one (ASIA C). In this group, 304 patients (98%) had an AO type A fracture.
Describe what you did.
Clinical and radiological data were evaluated, classifying the injuries by ASIA status, the Magerl/AO classification, and the TLICS score.
Describe your main findings.
The TLICS score ranged from 1 to 7 (mean 1.53, median 1). 307/310 (99%) patients matched the TLICS treatment (TLICS = 4), except three with distractive injuries (TLICS 7) initially misclassified as burst fractures. Nine patients (2.9%) were converted to surgical management. In group 2, 105 (70.9%) were ASIA E while 43 (29%) had some neurological deficit (ASIA A-D). 103 patients (69.5%) were classified as AO type A, 36 (24.3%) as type B, and 9(6%) as type C. T. Sixty-nine patients (46.6%) matched the TLICS recommendations; all discordant patients (53.4%) were treated for stable burst fractures (TLICS=2).
Describe the main limitation of this study.
This is a retrospective study.
Describe your main conclusion.
The TLICS treatment recommendation matched successful treatment in 301/310 patients (97.1%) in the conservative group.
Describe the importance of your findings and how they can be used by others.
However, in the surgical group, 53.4% of patients did not match TLICS recommendations, all were burst fractures without neurological injury (TLICS=2). This reflects continued inconsistencies in the treatment thoracolumbar burst fractures.
The Thoraco-Lumbar Injury Classification System (TLICS) system was
developed to improve injury classification and guide surgical
decision-making.
Our purpose was to validate this scoring system.
A retrospective analysis of 458 consecutive patients treated for thoracolumbar spine trauma from 2000 to 2010 at a single, tertiary medical center. 310 patients (67.6%) were treated conservatively (Group 1) and 148 patients (32.3%) were surgically (Group 2) treated. All patients in Group 1 were ASIA E, except one (ASIA C). In this group, 304 patients (98%) had an AO type A fracture.
Clinical and radiological data were evaluated, classifying the injuries by ASIA status, the Magerl/AO classification, and the TLICS score.
The TLICS score ranged from 1 to 7 (mean 1.53, median 1). 307/310 (99%) patients matched the TLICS treatment (TLICS = 4), except three with distractive injuries (TLICS 7) initially misclassified as burst fractures. Nine patients (2.9%) were converted to surgical management. In group 2, 105 (70.9%) were ASIA E while 43 (29%) had some neurological deficit (ASIA A-D). 103 patients (69.5%) were classified as AO type A, 36 (24.3%) as type B, and 9(6%) as type C. T. Sixty-nine patients (46.6%) matched the TLICS recommendations; all discordant patients (53.4%) were treated for stable burst fractures (TLICS=2).
This is a retrospective study.
The TLICS treatment recommendation matched successful treatment in 301/310 patients (97.1%) in the conservative group.
However, in the surgical group, 53.4% of patients did not match TLICS recommendations, all were burst fractures without neurological injury (TLICS=2). This reflects continued inconsistencies in the treatment thoracolumbar burst fractures.
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