Is the Thoracolumbar AOSpine Injury Score Superior to the Thoracolumbar Injury Classification and Severity Score for Guiding the Treatment Strategy of Thoracolumbar Spine Injuries?

An, Zhongcheng; Zhu, Yuejin; Wang, Guoqiang; Wu, Hao; Dong, Liqiang

doi:10.1016/j.wneu.2020.02.013

Cited by 18 publications

(25 citation statements)

References 25 publications

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“…In another retrospective study by Dodwad et al [16] that included 201 patients with thoracolumbar junction injuries revealed that the TLICS system agreed with the treatment plan at their institute in 98% of the time in conservatively managed patients and in 78% of the time in patients who underwent surgical intervention. This is in keeping with a study by An et al [17] whose results revealed revealing that TLICS matched 87.27% patients without neurological deficit. This is also matching with our results as the TLICS matched treatment recommendation in 60 patients (85.7%).…”

Section: Discussionsupporting

confidence: 93%

“…Those cases were treated surgically to decrease the probability for kyphosis deformity compared with conservative treatment. The TL AOSIS system differentiate between the rather benign incomplete burst fractures involving one end plate (typically treated conservatively), and the rather unstable complete burst fracture [18] Also in a study done by An et al [17] 110 patients were studied. The TL AOSIS matched the recommendations for the management of 108 patients (98.18%) while TLICS matched in 96 patients (87.27%).…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of MRI (TLICS vs AOSIS) in assessment of thoracolumbar spine injuries for guiding treatment

Nagi

Sakr

2022

Egypt J Radiol Nucl Med

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Background The thoracic segment represents the most common area fractured in the whole spine. Complete neurological deficits are commonly associated with thoracic injuries possibly due to a relatively small canal diameter as compared to the cervical or lumbar spine. Magnetic resonance is the gold standard of imaging, especially in patients suffering from neurological deficits as well as in soft tissue assessment mainly the disc, ligaments, and neural elements. The thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AO Spine injury score (TLAOSIS), are two scoring systems designed to help surgeons in management plans of thoraco-lumbar injuries. The aim of our study is to compare these two main thoracolumbar injury classification systems in deciding the management strategies in thoraco-lumbar injuries. This study is a retrospective study that included 70 patients (42 males and 28 females) who suffered acute traumatic vertebral fractures. All patients underwent MRI including T1WI, T2W and STIR sequences. The MRI was viewed by two independent radiologists of 5- and 10-years’ experience and compared to surgical decisions. Results Out of 70 patients included in our study, the TL AOSIS matched treatment recommendation in 62 patients (88.6%), and the TLICS matched in 60 patients (85.7%). The TL AOSIS achieved sensitivity 95%, specificity 80%, while the TLICS achieved sensitivity 72.2%, specificity 100%. Conclusion Both TL AOSIS and TLICS have very close results in their reliability for guiding treatment strategy, yet TL AOSIS matched treatment recommendation more than TLICS, with sensitivity more than TLICS, while TLICS had more specificity.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Accuracy of MRI (TLICS vs AOSIS) in assessment of thoracolumbar spine injuries for guiding treatment

Nagi

Sakr

2022

Egypt J Radiol Nucl Med

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“…Despite the increased reliability of the TLICS in the management of unstable burst fractures, the Thoracolumbar AOSpine Injury Score was recommended as more reliable than the TLICS system in the treatment of burst fractures, fracture classification, and morphology [24][25][26]. A potential explanation for the inconsistencies is that the TLICS system is that it does not consider particular factors such as segmental kyphosis, loss of vertebral height, and degree of canal compromise for guiding surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Thoracolumbar Injury Classification in the Clinical Outcome of Operative and Non-Operative Treatments

Smith¹,

Abdulazeez²,

ElGawady³

et al. 2021

Cureus

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This review assesses the validity of a biomechanical approach using finite element analysis in the Thoracolumbar Injury Classification and Severity Score System (TLICS) by addressing the “gray zone” decision discrepancy of thoracolumbar spinal injuries. A systematic review was performed using the keywords “Thoracolumbar Injury Classification” AND “finite element analysis of the spinal column” to evaluate the validity of the TLICS and finite element analysis of the thoracolumbar spinal column. Results were classified according to the main conclusions and level of evidence. Thirteen articles are included. Four of the articles evaluated the TLICS in comparison to other classification systems of thoracolumbar spinal injuries. A notable finding is that the TLICS had inconsistencies with other classification systems in the treatment of burst fractures without neurological deficits. One article evaluated the TLICS with the inclusion of magnetic resonance imaging (MRI) in the evaluation, which decreased the agreement between the suggested and actual treatment. Among the three finite element analysis studies, limited data have been published on the posterior ligamentous complex (PLC) status when an injury is suspected or indeterminate. The TLICS has been a reliable classification system in the management of single-column fractures and three-column injuries treated with surgical stabilization. Special attention to enhancing the TLICS classification system by eliminating the “gray zone” of a TLICS score of 4 is essential. Biomedical computational modeling evaluating the PLC status of indeterminate or injury suspected is needed to enhance the current TLICS system and to clarify the decision discrepancy in the “gray zone.”

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“…The researchers concluded that the TLICS is considered a widely deemed reliable tool compared to Denis and AO classification systems. [57][58][59]…”

Section: Classification Of Thoracolumbar Spine Fracturesmentioning

confidence: 99%

Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

et al. 2021

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Thoracolumbar spine is the most injured spinal region in blunt trauma. Literature on the indications for nonoperative treatment of thoracolumbar fractures is conflicting. The purpose of this systematic review is to clarify the indications for nonsurgical treatment of thoracolumbar fractures. We conducted a systematic literature search between 2010 to 2020 on PubMed/MEDLINE, and Cochrane Central. Up-to-date literature on the indications for nonoperative treatment of thoracolumbar fractures was reviewed to reach an agreement in a consensus meeting of WFNS (World Federation of Neurosurgical Societies) Spine Committee. The statements were voted and reached a positive or negative consensus using the Delphi method. For all of the questions discussed, the literature search yielded 1,264 studies, from which 54 articles were selected for full-text review. Nine studies (4 trials, and 5 retrospective) evaluating 759 participants with thoracolumbar fractures who underwent nonoperative/surgery were included. Although, compression type and stable burst fractures can be managed conservatively, if there is major vertebral body damage, kyphotic angulation, neurological deficit, spinal canal compromise, surgery may be indicated. AO type B, C fractures are preferably treated surgically. Future research is necessary to tackle the relative paucity of evidence pertaining to patients with thoracolumbar fractures.

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Is the Thoracolumbar AOSpine Injury Score Superior to the Thoracolumbar Injury Classification and Severity Score for Guiding the Treatment Strategy of Thoracolumbar Spine Injuries?

Cited by 18 publications

References 25 publications

Accuracy of MRI (TLICS vs AOSIS) in assessment of thoracolumbar spine injuries for guiding treatment

Accuracy of MRI (TLICS vs AOSIS) in assessment of thoracolumbar spine injuries for guiding treatment

The Effect of Thoracolumbar Injury Classification in the Clinical Outcome of Operative and Non-Operative Treatments

Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

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