Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety

Abstract

Study Design Systematic literature review. Objective The Thoracolumbar Injury Classification and Severity Score System (TLICS) is widely used to help guide the treatment of thoracolumbar spine trauma. The purpose of this study is to evaluate the safety of the TLICS in clinical practice. Methods Using the Medline database without time restriction, we performed a systematic review using the keyword “Thoracolumbar Injury Classification,” searching for articles utilizing the TLICS. We classified the results according to their level of evidence and main conclusions. Results Nine articles met our inclusion and exclusion criteria. One article evaluated the safety of the TLICS based on its clinical application (level II). The eight remaining articles were based on retrospective application of the score, comparing the proposed treatment suggested by the TLICS with the treatment patients actually received (level III). The TLICS was safe in surgical and nonsurgical treatment with regards to neurologic status. Some studies reported that the retrospective application of the TLICS had inconsistencies with the treatment of burst fractures without neurologic deficits. Conclusions This literature review suggested that the TLICS use was safe especially with regards to preservation or improvement of neurologic function. Further well-designed multicenter prospective studies of the TLICS application in the decision making process would improve the evidence of its safety. Special attention to the TLICS application in the treatment of stable burst fractures is necessary.

A novel retractor for reducing operation time and radiation exposure in percutaneous pedicle screw placement

“…All patients underwent posteroanterior and lateral X-ray examination, computed tomography (CT) scan (including CT in combination with a 3-dimensional reconstruction), BMD measurement, and magnetic resonance imaging (MRI) examination. The injury severity was determined by The thoracolumbar injury classification system (TLICS) [12][13][14]. Within the 126 patients, 57 cases received surgery with the application of the novel retractor (novel retractor group, group A), the other 69 patients were treated through the traditional fluoroscopic method (traditional group, group B).…”

Efficacy of percutaneous short segment fixation on the treatment of Magerl A3 thoracolumbar fractures: a retrospective study

“…The thoracolumbar (TL) region (T11-L3) is the most common area of spinal fractures due to its biomechanical characteristics; TL fractures account for 60-70% of spinal fractures (1,2). As the population ages, an increasing number of TL fractures accompanied with low bone mineral density (BMD) will occur, however, its treatment is controversial (3).…”

Burst Fractures in the Thoracolumbar Junction: What Do We Know About Their Treatment?

“…Although all these radiological features are potentially associated with a worse outcome, the evidences that indicate surgery are generally weak. Many systematic literature reviews, meta-analysis and ever-comparative clinical studies did not support their routine use for routine decision for surgical treatment in burst fractures without neurological deficits (4,(16)(17)(18).…”

“…Magnetic resonance imaging may show signs of severe injuries that would be underestimated in some cases using plain radiographs or CT scan. However, MRI changes must be interpreted together with CT scan, once its use isolated may lead to unnecessary surgeries (1,4,9,14,17,19).…”

“…Finally, in our routine practice, after a CT scan and an MRI, in patients with burst fractures without deficits who will be potentially treated non surgically, we routinely perform a standing plain radiograph on lateral view before hospital discharge for the following reason: to evaluate the effects of patient weight load in the fracture spine, potentially revealing occult ligamentous injury, even in the setting of a "near normal" MRI (17,21). If patients tolerate their pain in orthostasis and do not show any sign of evident acute instability, conservative treatment is established, with a close clinical and radiological follow up until fracture healing, generally in 8 to 12 weeks (22).…”