Clinical relevance and validity of TLICS system for thoracolumbar spine injury

Abstract

In order to enhance the reliability of the application to clinical practice of the TLICS classification, we retrospectively reviewed the patients with thoracolumbar spine injuries who underwent magnetic resonance imaging (MRI) and analyzed the validity of the TLICS classification and the necessity of MRI. We enrolled 328 patients with thoracolumbar spine injury who underwent MRI. All patients were classified into conservative and operative treatment groups. The TLICS score of each group was analyzed and the degree of consistent with the recommended treatment through the TLICS classification was examined. Of the total 328 patients, 138 patients were treated conservatively and 190 patients were treated by surgery. Of the 138 patients who underwent conservative treatment, 131 patients (94.9%) had a TLICS score of 4 points or less, and matched with the recommendation score for conservative treatment according to the TLICS classification (match rate 94.9%, 131/138). Of the 190 patients who underwent operative treatment, 160 patients (84.2%) had a TLICS score of 4 points or more (match rate 84.2%, 160/190). All of 30 mismatched patients with a TLICS score of 3 points or less (15.8%) had stable burst fracture without neurological deficit. We retrospectively reviewed the validity of the TLICS classification for the injuries of the thoracolumbar spine, based on MRI in a large group of patients. Treatment with TLICS classification showed high validity, especially in conservative group, and MRI should be an essential diagnostic tool for accurate evaluation of posterior ligamentous complex injury.

Automated prediction of the Thoracolumbar Injury Classification and Severity Score from CT using a novel deep learning algorithm

“…6 For example, Park et al retrospectively reviewed 328 patients with thoracolumbar injuries and found that TLICS matched the decision for conservative treatment in 95% of cases and for operative treatment in 84% of cases. 4 Interestingly, while Dawkins et al found high interrater reliability using TLICS in a study of 81 pediatric patients, the reliability decreased when MRI was used by surgeons for injury assessment. 7 Our study demonstrates that a data-driven algorithm can reliably detect a suspected disruption of the PLC, in most cases, without the need for MRI.…”

“…3 There are several thoracolumbar injury classification methods used for clinical decision support, including the Magerl, Denis, and McAfee classification systems. 4 Nonetheless, the decision to operate can be controversial given difficulties in predicting the stability of spine injuries and a lack of clear treatment guidelines. The Thoracolumbar Injury Classification and Severity Score (TLICS) was proposed in 2005 to provide a classification system that accounted for neurological deficits and spinal stability and is intended to provide guidelines for operative and nonoperative decision-making.…”

Early Surgical Treatment of Thoracolumbar Fractures With Thoracolumbar Injury Classification and Severity Scores Less Than 4

“…Our delayed surgical intervention rate of 1.4% is much lower than previously reported literature ranging from 4.7% to 25%. 10,11,14,15 Figure 1…”

“…The TLICS score comprises three major components: morphology of the fracture (compression [11], burst [12], translational/rotational [13], distraction [14]), amount of neurologic involvement (intact [10], nerve root/complete cord [12], incomplete cord/cauda equina [13]), and injury to the posterior ligamentous complex (indeterminate/suspected injury [12], injury [13]). A more severe injury is represented by a higher TLICS score.…”

Adult Trauma Patients With Thoracolumbar Injury Classification and Severity Score of 4

“…12 Two studies, representing the second and third largest series, focused on TLJ where 59 (11.15%) of 529 patients were To4; 37 (62.71%) of To4 in the TLJ were operative (Table 4). 9,15 .…”