Outcomes in Thoracolumbar Burst Fractures With a Thoracolumbar Injury Classification Score (TLICS) of 4 Treated With Surgery Versus Initial Conservative Management

Nataraj, Andrew; Jack, Andrew; Ihsanullah, Ihsanullah; Nomani, Shawn; Kortbeek, Frank; Fox, Richard

doi:10.1097/bsd.0000000000000656

Cited by 21 publications

(33 citation statements)

References 19 publications

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“…[14] This study demonstrated that conservative treatment for TLICS 4 thoracolumbar fractures could be safely applied and the conservative treatment of cases scoring TLICS 4 is equally effective to those scoring ≤3. Furthermore, Nataraj et al [15] found no significant difference in terms of ODI, VAS score and time to return to work in another study comparing surgically-and conservatively-treated patients during sixmonth follow-up. Compared with the previous studies, the sample size was relatively larger and the mean follow-up period was relatively longer in the present study.…”

Section: Discussionmentioning

confidence: 94%

Management of thoracolumbar injury classification and severity score of 4 (TLICS=4) thoracolumbar vertebra fractures: surgery versus conservative treatment

Karaali

Çiloğlu

Duramaz

et al. 2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: This study aims to compare clinical and radiographic outcomes of surgical treatment and conservative treatment with bracing in neurologically intact patients with score 4 of TLICS thoracolumbar vertebra fractures. METHODS:Patients with traumatic thoracolumbar junction fractures (T11-L2), the score of TLICS 4, and minimum 24-month follow-up were included in this study. Patients were divided into surgery and bracing groups. The groups were compared concerning clinical and demographical features, local kyphotic angles (LKA), vertebra height loss percentage (VHL), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and time to return to work. RESULTS: There were 74 patients (71 males, 3 females) in the surgery group and 76 patients (58 males, 18 females) in the bracing group. Although the surgery group showed better improvement in VAS scores within six months postoperatively, no significant difference was observed at the 24 th -month evaluation (p<0.001 and p=0.270, respectively). ODI, LKA and VHL were significantly lower in the surgery group (p<0.001, p<0.001 and p<0.001, respectively). In addition, return to work was significantly earlier in the surgery group (p<0.001). CONCLUSION:The findings obtained in this study suggest that the surgical treatment for TLICS 4 patients with thoracolumbar fractures has better clinical and radiographic outcomes than the bracing. Moreover, returning time to the work of patients is shortened with surgical treatment. The surgical treatment seems to be the first and the appropriate choice in the management of TLICS 4 thoracolumbar vertebral fractures.

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Section: Discussionmentioning

confidence: 94%

Management of thoracolumbar injury classification and severity score of 4 (TLICS=4) thoracolumbar vertebra fractures: surgery versus conservative treatment

Karaali

Çiloğlu

Duramaz

et al. 2020

Ulus Travma Acil Cerrahi Derg

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“…However, its biggest disadvantage is that accurate decision-making is difficult when choosing the appropriate treatment for TLICS 4 thoracolumbar fractures. The treatment of patients with TLICS 4 is currently the most important and focused 15,16 . Although many studies point to the fact that both operative and conservative treatments yield similar clinical outcomes in patients with TLICS 4 fractures, some studies show that the clinical outcomes vary according to the treatment selected 5,[12][13][14] .…”

Section: Resultsmentioning

confidence: 99%

Clinical relevance and validity of TLICS system for thoracolumbar spine injury

Park

Kim

Lee

et al. 2020

Sci Rep

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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.

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“…According to the guidelines, surgical treatment is recommended when the Thoracolumbar Injury Classification and Severity Scale (TLICS) score is higher than 4 points, whereas conservative treatment is recommended when the TLICS score is lower than 4. When the TLICS score is equal to 4 points, the appropriate scheme should be selected according to the patient’s condition [ 25 , 26 ]. A double-blind clinical trial conducted by Alireza Mohamadi found that for cases in which the TLICS score was equal to 4 points, based on the local sagittal angle and regional sagittal angle and visual analog scale score, the recovery effect of the surgery group was better than that for the conservative treatment group [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and therapeutic value of delayed surgery in patients with symptomatic old thoracolumbar fractures

Huang

Liang

et al. 2021

BMC Surg

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Background To investigate the clinical efficacy and therapeutic value of posterior decompression reduction, bone grafting fusion, and internal fixation for treatment of symptomatic old thoracolumbar fractures. Method Retrospective analysis was conducted for 14 patients (9 men, 5 women; average age 40.1 years) with old thoracolumbar fractures who underwent posterior operation. American Spinal Injury Association (ASIA) scores were used to evaluate neurologic function. Vertebral body height, Cobb angle in the sagittal plane, spinal canal volume ratio (%) and bone graft fusion were analyzed by radiography and computed tomography on different follow-up times. Results Mean follow-up was 27.1 months (23–36 months). Of three patients with ASIA grade A, 2 had improved postoperative urination and defecation, although no classification change. Preoperative ASIA score for eight patients with incomplete injury was grade B; four patients recovered to grade C at final follow-up. Preoperative ASIA score was C in three patients, increased to D in two patients and returned to normal E in one patient. Preoperative results showed average injured vertebra height loss rate decreased from 50.4 to 8.9%; average Cobb angle on the sagittal plane recovered from 39.6 to 6.9°; and the average spinal canal volume ratio recovered from 33.8 to 5.9%. Bony fusion was achieved; local lumbago and leg pain were relieved to some extent. No patients exhibited loosening of the fracture treated by internal fixation, pseudoarthrosis, or other related serious complications. Conclusion Treatment of old thoracolumbar fractures by posterior decompression reduction, bone grafting fusion, and internal fixation can relieve spinal cord compression, improve neurologic function of some patients (ASIA grades B–C), effectively relieve pain, correct deformity, restore biomechanical stability, and significantly improve quality of life.

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Outcomes in Thoracolumbar Burst Fractures With a Thoracolumbar Injury Classification Score (TLICS) of 4 Treated With Surgery Versus Initial Conservative Management

Abstract: Level III.

Cited by 21 publications

References 19 publications

Management of thoracolumbar injury classification and severity score of 4 (TLICS=4) thoracolumbar vertebra fractures: surgery versus conservative treatment

Management of thoracolumbar injury classification and severity score of 4 (TLICS=4) thoracolumbar vertebra fractures: surgery versus conservative treatment

Clinical relevance and validity of TLICS system for thoracolumbar spine injury

Clinical efficacy and therapeutic value of delayed surgery in patients with symptomatic old thoracolumbar fractures

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