Clinical results of patients with thoracolumbar spine trauma treated according to the Thoracolumbar Injury Classification and Severity Score

Clinical article

Andrei F. Joaquim M.D., Ph.D.1, Enrico Ghizoni M.D., Ph.D.1, Helder Tedeschi M.D., Ph.D.1, Ulysses Caus Batista M.D.1, and Alpesh A. Patel M.D.2
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  • 1 Division of Neurosurgery, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; and
  • | 2 Department of Orthopaedics, Northwestern University, Chicago, Illinois
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Object

The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed to improve injury classification and guide surgical decision making, yet validation remains necessary. This study evaluates the neurological outcome of patients with thoracolumbar spine trauma (TLST) treated according to the TLICS.

Methods

The TLICS was prospectively applied to a consecutive series of patients treated for TLST between 2009 and 2012. Patients with a TLICS of 4 points or more were surgically treated, whereas patients with a TLICS of 3 points or fewer were conservatively managed. The primary outcome was the American Spinal Injury Association Impairment Scale (AIS).

Results

A total of 65 patients were treated. In 37 patients, the TLICS was 3 points or fewer and the patients were treated nonsurgically (Group 1). The remaining 28 patients with a TLICS of 4 or more points underwent surgical treatment (Group 2). In Group 1, 28 patients underwent some follow-up at the authors' institution; all of these patients were neurologically intact with compression or burst fractures (TLICS of 1 or 2 points; median 2). The average age in this group was 44.5 years, and follow-up ranged from 1 to 36 months (mean 6.7 months, median 3 months). Two patients (both with a TLICS of 2 points) underwent late surgery for axial back pain and mild focal kyphosis, without significant clinical improvement. In Group 2, follow-up ranged from 1 to 18 months (mean 4.4 months, median 3 months) and the TLICS ranged from 4 to 10 points (median 7 points). In this group, preoperatively, 9 (32%) patients had AIS Grade E injuries, 6 (21%) had AIS Grade C, 1 (4%) had AIS Grade B, and 12 (43%) had AIS Grade A injuries. At the final follow-up, the AIS grade was E in 11 patients (39%), D in 5 (18%), and A in 12 (43%). No patient had neurological worsening during the follow-up.

Conclusions

The TLICS can be used to guide treatment that is safe with regard to the neurological status of patients treated for TLST.

Abbreviations used in this paper:

AIS = American Spinal Injury Association Impairment Scale; PLC = posterior ligamentous complex; TLICS = Thoracolumbar Injury Classification and Severity Score; TLST = thoracolumbar spinal trauma.

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