Classification systems for acute thoracolumbar trauma

Fassett, Daniel R.; Politi, Roman; Patel, Archit; Brown, Zoë; Vaccaro, Alexander R.

doi:10.1097/bco.0b013e32810498d0

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…But a few of them are used in daily clinical routine. An ideal classification for thoracolumbar fractures still remains to be difficult [7,16,24,33].…”

Section: Discussionmentioning

confidence: 99%

“…New classification scores paying intention to the integrity of the dorsal ligament complex [11,[31][32][33] have been developed. For example, by using the Thoracolumbar Injury Classification and Severity Score [7,32] the integrity of the PLC, injury morphometries, injury morphology and neurological impairment should lead to the correct treatment decision.…”

Section: Discussionmentioning

confidence: 99%

“…Injuries to the PLC structures still influence the way of its treatment. Even so the most common classification systems-the AO comprehensive fracture classification system according to Magerl and the Denis classification, e.g., pay attention to injuries of the dorsal column [6,7,13,[19][20][21]. Further description of fracture morphology in this study is classified according to the AO system [19].…”

Section: Introductionmentioning

confidence: 99%

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Is there a way to diagnose spinal instability in acute burst fractures by performing ultrasound?

et al. 2009

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The aim of this study is to examine the predictive value of ultrasound diagnostics for the assessment of traumatic lesions of the posterior ligament complex (PLC) in burst fractures of the thoracolumbar spine. This was a prospective validating cohort study. Judgment about instability and treatment of burst fractures depends on the condition of the PLC. There have been some studies describing underdiagnosis of PLC injuries due to classification problems in ligamentary distraction type fractures. The gold standard for assessing these lesions is magnetic resonance imaging (MRI). Even then, there are often limits in contemporary operational availability and technical limitations of MRI. Ultrasound was described being an alternative. In a prospective study, 54 levels of 18 patients with acute burst fractures of the thoracic and lumbar spine have been examined by ultrasound and additional MRI scans preoperatively. The condition (intact vs. ruptured) of supraspinous ligament (SSL) and the interspinous ligament has been assessed for the ligaments separately. Hematoma below the SSL has also been evaluated as an indirect sign of an injured PLC. In all the patients the primary performed operative treatment was a posterior spinal instrumentation. Postoperatively the blinded results of the ultrasound procedures have been matched against intraoperative and MRI findings. Assessments of all target structures have been contributed to the calculation of the sensitivity and specificity of ultrasound. A total of 18 patients, 14 males and 4 females, with acute burst fractures have been qualified for inclusion in the study. The patients' mean age was 43.4 years. Comparing intraoperative findings with preoperatively performed investigations, ultrasound archived a sensitivity of 0.99 and a specificity of 0.75 (P < 0.05) to detect traumatic lesions to the PLC. As hypothesized the obtained predictive value using ultrasound correlates closely with intraoperative findings. Anyway MRI still seems to be the superior diagnostic method for examining the PLC. However, ultrasound can be considered to be an adequate alternative method in cases with contraindications for MRI such as ferromagnetic side effects, claustrophobia, availability or emergency diagnostics in multiple injuries.

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“…But a few of them are used in daily clinical routine. An ideal classification for thoracolumbar fractures still remains to be difficult [7,16,24,33].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is there a way to diagnose spinal instability in acute burst fractures by performing ultrasound?

et al. 2009

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“…[20][21][22] The Spine Trauma Study Group's (STSG's) TLICS is the most recent attempt at devising a clinically reliable and valid system. Originally proposed as the Thoracolumbar Injury Severity Score (TLISS), 30 and modified to become the TLICS, 22,31,32 this classification system presents a scoring mechanism to be used by care providers to assist in the decision between operative and nonoperative treatment. This scoring system is based on three variables corresponding to the spinal injury: the morphological appearance of the fracture, the integrity of the posterior ligamentous complex, and the patient's neurological status ( Fig.…”

Section: Advancements In Surgical Instrumentationmentioning

confidence: 99%

4 The Impact of Evidence-Based Medicine in Thoracolumbar Trauma

Vaccaro¹,

Fehlings²,

Dvorak³

2011

Spine and Spinal Cord Trauma

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“…The management of these fractures in the dorsolumbar segment of the spine has been the subject of controversy for many years. [3] The advantages of surgery include a shorter period of bed rest and hospitalization, better correction of kyphotic deformity, avoidance of later deterioration caused…”

Section: Introductionmentioning

confidence: 99%

Results with non-operative treatment in dorsolumbar fractures with no neurological deficit: A functional assessment

Kansal¹,

Agrawal²,

Patel³

2013

Int J Med Sci Public Health

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Background: The purpose of this prospective study was to assess the functional outcome of conservative treatment with early ambulation of dorso-lumbar spine fractures with no neurological deficit. Aims & Objective: The purpose of this prospective study was to identify the risk factors for dorso-lumbar spine injuries, and to assess the efficacy of non-operative treatment with early ambulation, and functional outcome of the patients. Material and Methods: From October 2008 to June 2010, 48 consecutive patients with single-level thoracolumbar spinal injury, with no neurological deficit were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months, and early ambulation was recommended. Patients were evaluated as per TLICS score, and if score was <=4 with no neurological deficit then, they were treated with conservative treatment and included in the study. The Denis Pain and Work Scale were used to assess the clinical outcome. The average follow-up period was 6.5 months (range, 4 to 11 months). Statistical analysis done by observational descriptive statistics using SPSS 19.0. Results: Radiological parameters, such as Cobb's angle, showed loss of fracture reduction, which was not statistically significant. However, the functional outcome was satisfactory in 40 out of 48 patients, with no complications recorded on completion of treatment. Conclusion: Conservative treatment with early mobilization using TLS orthosis had good results in patients with TLICS score <4. We support the concept that TLICS is a reliable and easy-to-use classification for the conservative treatment and prognosis of thoracolumbar spinal fractures.

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Classification systems for acute thoracolumbar trauma

Cited by 5 publications

References 17 publications

Is there a way to diagnose spinal instability in acute burst fractures by performing ultrasound?

Is there a way to diagnose spinal instability in acute burst fractures by performing ultrasound?

4 The Impact of Evidence-Based Medicine in Thoracolumbar Trauma

Results with non-operative treatment in dorsolumbar fractures with no neurological deficit: A functional assessment

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