PurposeOn the basis of the Thoracolumbar Injury Classification and Severity Score (TLICS), an modified TLICS classification system was presented, its reliability and repeatability were assessed, and the factors influencing classification consistency were examined.MethodsFive spinal surgeons were chosen at random. The clinical data of 120 patients with thoracolumbar fractures admitted to the Department of Spine Surgery, Ningbo Sixth Hospital from December 2019 to June 2021 were categorized using the modified TLICS system. After 6 weeks, disrupt the order of data again. Using unweighted Cohen's kappa coefficients, the consistency of the modified TLICS system was assessed in five aspects: neurofunctional status, disc injury status, fracture morphology, posterior ligament complex (PLC) integrity, and treatment plan.ResultsIn terms of reliability, the average kappa values for the subclasses of the modified TLICS system (neurofunctional status and disc injury status) were 0.920 and 0.815, respectively, reaching the category of complete confidence. Fracture morphology and treatment plan had average kappa values of 0.670 and 0.660, respectively, which were basically reliable. The average kappa value of PLC integrity was 0.453, which belonged to the category of moderate confidence. The average kappa coefficients of each subcategory (neurological status, disc injury status) had excellent consistency, and the kappa values were 0.936 and 0.879, respectively, which belonged to the completely credible category. The kappa values of fracture morphology and treatment plan repeatability were 0.772 and 0.749, respectively, reaching the basic credibility category. PLC integrity repeatability kappa value is low, 0.561, to moderate credibility category.ConclusionThe modified TLICS system is intuitive and straightforward to understand. The examination of thoracolumbar fracture injuries is more exhaustive and precise, with excellent reliability and repeatability. The examination of neurological status and disc injury status is quite reliable and consistent. The consistency of fracture morphology is slightly poor, which is basically credible; the PLC integrity consistency is poor, reaching a reliability level of moderate, which may be associated with the subjectivity of clinical evaluation of PLC.
Objective: To propose a modified TLISC system with reference to the Thoracolumbar Injury Classification and Severity Score (TLICS) and prospectively study the feasibility of its guiding clinical treatment. Methods: The study cohort population was 120 patients with thoracolumbar segment fractures admitted to the Department of Spine Surgery of the Sixth Hospital of Ningbo from December 2019 to June 2021, all within one week after fracture, with fracture segments of T11-L2 segments, 68 males and 52 females, aged 22-65 (36.7±5.7) years. The fracture morphology, neurological status, posterior ligament complex (PLC) integrity and disc injury status were combined to assess the fracture severity and formulate clinical treatment strategies based on the total score (T, 0-12 points). The anterior height of the injured spine before and after treatment, the posterior convexity Cobb angle, the VAS score and the spinal nerve function classification and recovery were compared. Results: Based on the scores, 28 cases were finally treated conservatively and 92 cases were treated surgically. Of the 92 surgically treated patients, 8(8.7%) were treated with an anterior approach, 81 (88.0%) with a posterior approach, and 3 (3.3%) with a combined anterior-posterior approach. All patients were followed up for 11 to 27 months [(19.2 ± 4.6) months] after discharge from the hospital. The VAS score at the last follow-up after treatment was 1.94±0.52, the height ratio of the anterior margin of the injured spine was 87.10±7.17%, the sagittal index was 90.35±7.72%, and the Cobb angle was 3.05±0.97 degrees, which were not statistically different from 1 month after treatment (P>0.05) and statistically different from before treatment (P<0.05), and the neurological functional status also had The neurological functional status also improved to different degrees. At the last follow-up, there were 2 cases of broken pedicle screws and no case of broken rods, and 7 cases of pedicle screws with different degrees of wear and cut in the vertebral body, manifesting as mild or severe low back pain. Conclusion: The modified TLICS scoring system is practical in the assessment of thoracolumbar fracture staging and injury degree, and has certain guiding significance for clinical treatment.
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