Evaluation of the Thoracolumbar Injury Classification System in Thoracic and Lumbar Spinal Trauma

Joaquim, Andrei Fernandes; Fernandes, Yvens Barbosa; Cavalcante, Rodrigo; Fragoso, Rodrigo M.; Honorato, Donizeti César; Patel, Alpesh A.

doi:10.1097/brs.0b013e3181c95047

Cited by 78 publications

(74 citation statements)

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“…In addition, it neither provides prognostic information nor accounts for the neurological status of the patient and, therefore, does not adequately guide surgical decision making. 22 The original concept of instability has been oversimplified to state that it exists if two of three columns are disrupted, thus requiring operative stabilization in these cases. Several studies have, however, shown that non-operative treatment of two-column injuries may achieve a satisfactory outcome.…”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27] In addition, the AO system does not account for the patient's neurological status, a critical determinant of surgical decision making. 22 TLICS, the most recent classification system for thoracolumbar spine injuries, also has its limitations. Most of the investigations with regard to it have been performed by individuals who were involved with its development, and majority of the published data is based on retrospective studies.…”

Section: Discussionmentioning

confidence: 99%

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Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert’s perspective?

2014

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Study design: Online questionnaire survey. Objective: To obtain the opinion of experts on whether the currently available classification systems for thoracolumbar and subaxial cervical spine injuries meet their expectations with regard to the desired objectives of a good classification system and practical implementability. Methods: An online survey was conducted during August-September 2013 using a specially designed questionnaire. Members of Spine Trauma Study Group of International Spinal Cord Society and other spinal injury experts were approached, and responses were analyzed. Results: Forty-two spine experts responded. Majority (87.50%, n = 35) were involved with education and research. For subaxial cervical spine injuries, Allen Ferguson classification was more commonly used (37.50%, n = 15) and thought to be practically implementable in day-to-day practice (30.77%). For thoracolumbar injuries, while Thoracolumbar Injury Classification and Severity Score (TLICS) was more commonly used (47.50%, n = 19), the response of experts for practical implementability in day-to-day practice was more evenly distributed among TLICS, AO (Association for Osteosynthesis) and Dennis classifications (30.77, 23.08 and 25.64%, respectively). Experts felt that the classification systems did not serve all the desired objectives. The reliability for residents was especially a concern. Conclusion: We may still be far from an ideal classification system. Many experts continue to prefer or would consider shifting back to traditional and simpler systems. There is a need for developing classification systems that would be better implementable practically in day-to-day clinical practice, better guide treatment, be more reliable, incorporate other modifiers influencing treatment and be more comprehensive in that order of priority.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert’s perspective?

2014

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“…23,71 Both TLICS and SLIC incorporate the same 3 categories of injury characteristics: injury morphology, integrity of the PLC or discoligamentous complex (DLC), and neurological status (Table 1). 44,63 The TLICS and SLIC sum the patient score in each category, and the final score determines the next treatment step. A score < 4 suggests nonoperative management, 4 is borderline, and > 4 is an indication for operative management.…”

Section: Surgical Candidacy and Approachmentioning

confidence: 99%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord. There is general evidence for the maintenance of mean arterial pressure of > 85 mm Hg during immediate and acute care to optimize neurological outcome; however, the selection of vasopressor type and duration should be judicious, with considerations for level of injury and risks of increased cardiogenic complications in the elderly. Level II recommendations exist for early decompression, and additional time points of neurological assessment within the first 24 hours and during acute care are warranted to determine the temporality of benefits attributable to early surgery. Venous thromboembolism prophylaxis using low-molecular-weight heparin is recommended by current guidelines for SCI. For these patients, titration of tidal volumes is important to balance the association of earlier weaning off the ventilator, with its risk of atelectasis, against the risk for lung damage from mechanical overinflation that can occur with prolonged ventilation. Careful evaluation of infection risk is a priority following multisystem trauma for patients with relative immunosuppression or compromise. Although patients with polytrauma may experience longer rehabilitation courses, long-term neurological recovery is generally comparable to that in patients with isolated SCI after controlling for demographics. Bowel and bladder disorders are common following SCI, significantly reduce quality of life, and constitute a focus of targeted therapies. Emerging biomarkers including glial fibrillary acidic protein, S100β, and microRNAs for traumatic SCIs are presented. Systematic management approaches to minimize sources of secondary injury are discussed, and areas requiring further research, implementation, and validation are identified.

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“…Our analysis also corroborates the results for the reliability of the TLICS/TLISS classification, as excellent results were obtained in regard to agreement between the treatments indicated by the classification and the treatment indicated by the evaluating surgeons, as previously demonstrated in various publications. 10,7,8,12,14,15 We attribute the findings of our study to the fact that the new classification was well established before the case analysis. In addition to receiving the original article and a summary version in Portuguese a week earlier, on the day of the evaluation, the surgeons attended an oral presentation about the TLICS system and received an explanatory summary about it.…”

Section: Discussionmentioning

confidence: 70%

Interobserver evaluation of TLICS system to treat thoracolumbar fractures

et al. 2015

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Objective: To evaluate the interobserver agreement regarding the TLICS Classification (Thoracolumbar Injury Classification and Severity Score). Furthermore, evaluate the reliability, analyzing the correlation between the treatment indicated by TLICS system (surgical or conservative) and the treatment indicated by each evaluator surgeon. Methods: Imaging tests and clinical data of 22 patients with thoracolumbar fractures were analyzed by eight spine surgeons, and two main analyzes were performed: the first compared the interobserver agreement related to TLICS and the second compared the agreement between the treatment indicated by TLICS classification (surgical or conservative) and treatment indicated by each surgeon -based on his personal experience and the preferred classification. Results: Using the parameters of Landis and Koch for interpretation of Kappa value, the interobserver agreement of TLICS classification was considered moderate in our study (K=0.6). The agreement between the indications of treatment (surgical or conservative) dictated by the classification and the indication of each surgeon was considered excellent, with kappa value of 0.89. Conclusion: We believe that the classification is a good tool for the evaluation and the treatment indication in thoracolumbar fractures.Keywords: Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Spinal cord injuries. RESUMO Objetivos: Avaliar a concordância interobservadores com relação à Classificação TLICS (Thoracolumbar Injury Classification and Severity Score). Além disso, avaliar a confiabilidade, analisando a concordância entre o tratamento indicado pelo sistema TLICS (cirúrgico ou conservador) e o tratamento que cada cirurgião avaliador indicou. Métodos: Foram avaliados retrospectivamente exames de imagem e dados clínicos de 22 pacientes com fraturas toracolombares por oito cirurgiões de coluna vertebral. Duas análises principais foram realizadas: a primeira comparando a concordância do sistema TLICS interobservadores e a segunda comparando a concordância entre o tratamento indicado por essa classificação (cirúrgico ou conservador) e o tratamento que cada cirurgião indicou -com base em sua experiência pessoal e na classificação de escolha. Resultados: Utilizando os parâmetros de Landis e Koch para interpretação do valor de Kappa, a concordância interobservadores da classificação TLICS foi considerada moderada em nosso estudo, com valor de Kappa de 0,6. A concordância entre as indicações de tratamento (cirúrgico ou conservador) ditadas pela classificação e as indicações de cada cirurgião foi considerada excelente, com valor de

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Evaluation of the Thoracolumbar Injury Classification System in Thoracic and Lumbar Spinal Trauma

Abstract: The TLICS score treatment recommendation matched surgical treatment in 47 of 49 patients (96%). The TLICS was found to correlate to the AO classification. This suggests that the TLICS can be used to classify thoracolumbar trauma and can accurately predict surgical management.

Cited by 78 publications

References 11 publications

Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert’s perspective?

Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert’s perspective?

Update on critical care for acute spinal cord injury in the setting of polytrauma

Interobserver evaluation of TLICS system to treat thoracolumbar fractures

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