Is thoracolumbar injury classification and severity score (tlics) superior to ao thoracolumbar injury classification system for guiding the surgical management of unstable thoracolumbar burst fractures without neurologic deficit?

Yüksel, Mehmet Onur; Gürbüz, Mehmet Sabri; İş, Merih; Somay, Hakan

doi:10.5137/1019-5149.jtn.19094-16.2

Cited by 13 publications

(19 citation statements)

References 11 publications

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“…A notable finding is that the retrospective evaluation of the TLICS had inconsistencies with other classification systems in the treatment of burst fractures without neurological deficits. Additionally, a significant finding reported by Yuksel et al is the treatment decision discrepancy between the TLICS and AO classification systems in unstable burst fractures ( Table 2) [14]. Standardization of TL injury scores is crucial to guiding proper surgical management among treating physicians.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to the AO recommendations, TLICS may be more reliable in guiding the surgical management of unstable TL burst fractures without neurological deficits, as the AO system had recommended conservative treatment. However, the patient had an unstable burst fracture [14].…”

Section: Thoracolumbar Injury Classificationmentioning

confidence: 97%

“…Yuksel et al report that for patients with neurological deficits, both the TLICS and AO scoring systems recommended surgical treatment [14]. Of the 37 patients without neurological deficit, all patients received TLICS > 4, whereas 19 out of the 37 patients received an AO score between 1 to 3 points in which AO recommends conservative treatment ( Dawkins et al reported that the inclusion of magnetic resonance imaging (MRI) in the evaluation changed the final TLICS score leading to a decrease in the agreement between the suggested and actual treatment [15].…”

Section: Thoracolumbar Injury Classificationmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Thoracolumbar Injury Classificationmentioning

confidence: 97%

Section: Thoracolumbar Injury Classificationmentioning

confidence: 99%

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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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“…In past decades, the Denis 3-column system was used to classify TL fractures, but its clinical utility was limited, as it did not propose a treatment course or guided decisionmaking (9,10). Newer schemas base their classification on three components of injury: fracture morphology, neurological status, and integrity of ligamentous structures.…”

Section: Classification Systemsmentioning

confidence: 99%

The use of minimally invasive surgery in spine trauma: a review of concepts

et al. 2019

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Traumatic injuries to the spine can be common in the setting of blunt trauma and delayed diagnosis can have a deleterious effect on patients' health. The goals of treatment in managing spine trauma are prevention of neurological injury, providing stability to the spine, and correcting posttraumatic deformity. Minimally invasive spine surgery (MISS) techniques are an alternative to open spine surgery for treatment of spine fractures. MISS is also a viable treatment in the setting of damage control orthopedics, when patients with multiple traumatic injuries may be unable to tolerate a traditional open approach. MISS techniques have been used in the treatment of unstable fractures with or without spinal cord injury, flexion and extension-distraction injuries, and unstable sacral fractures. Traditional open surgeries have been associated with increased blood loss, longer operative times, and a higher risk for surgical site infection (SSI). MISS techniques have the potential to reduce open approach-associated morbidity, and improve postoperative care and rehabilitation. MISS techniques for spine trauma are an indispensable option in the treatment armamentarium of spine surgeons.

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“…1 The score has demonstrated acceptable reliability and validity in various studies and its recommendations were suggested to be of probable higher reliability than those of the AO thoracolumbar injury classification system particularly for guiding the surgical management of unstable burst fractures. 2 Although the resulting score can categorize patients into nonoperative (TLICS ≤ 3) and operative (TLICS ≥ 5) candidates, those patients with score 4 represent an indistinct group where either operative or nonoperative management may be conducted. Moreover, the score does not state the specifics of surgery in surgical candidates, basically, the surgical approach (anterior versus posterior) and the fixation type (open vs minimally invasive)…”

Section: Introductionmentioning

confidence: 99%

Candidates for Percutaneous Screw Fixation Without Fusion in Thoracolumbar Fractures: A Retrospective Matched Cohort Study

Alkosha

Omar

Albayar

et al. 2019

Global Spine Journal

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Study Design: Retrospective matched cohort study. Objectives: Identifying candidates for isolated percutaneous screw fixation (PSF) in thoracolumbar fractures based on Thoracolumbar Injury Classification and Severity (TLICS) score. Methods: Patients underwent PSF were split into 3 TLICS-score categories, then matched with groups having similar scores managed either non-operatively or via open screw fixation (OSF). Each category was assessed for corrective power and loss of correction by comparing initial and 1-year Cobb angles as well as Oswestry Disability Index and rates of fracture healing at 1 year. Results: A total of 102 patients (40 females) with age range 19 to 51 years, were admitted 1 to 25 hours following trauma. Each of TLISC categories consisted of matched treatment groups for comparison. In TLICS-3 fractures (2 treatment groups, n = 12 each), PSF showed similar outcomes but longer time to ambulation and length of stay (LOS) compared with nonoperative management. In TLICS-4 fractures (3 treatment groups, n = 18 each), PSF showed comparable corrective power and outcomes as OSF but was better in terms of operative time, blood loss, time to ambulation, LOS, and cosmesis. Despite higher LOS when compared with nonoperative cases, PSF showed superior radiologic and functional outcomes. In TLICS-5 fractures (2 treatment groups, n = 12 each), PSF showed shorter admissions and time to ambulation but lower corrective power, functional recovery, and tendency to lower healing rates. Conclusions: Isolated PSF is a valid choice in managing TLICS-4 thoracolumbar fractures; however, it did not surpass conventional methods in TLICS-3 or TLICS-5 fracture types. Further studies are needed before the generalization of findings.

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Is thoracolumbar injury classification and severity score (tlics) superior to ao thoracolumbar injury classification system for guiding the surgical management of unstable thoracolumbar burst fractures without neurologic deficit?

Cited by 13 publications

References 11 publications

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

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

The use of minimally invasive surgery in spine trauma: a review of concepts

Candidates for Percutaneous Screw Fixation Without Fusion in Thoracolumbar Fractures: A Retrospective Matched Cohort Study

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