How Should Patients with a Thoracolumbar Injury Classification and Severity Score of 4 Be Treated?

Abstract

The thoracolumbar injury classification and severity score (TLICS) system help surgeons decide whether patients should undergo initial operative treatment or nonoperative treatment. However, the best treatment for patients with TLICS 4 fracture remains unknown. The aim of this study was to identify the risk factors for nonoperative treatment failure in patients with TLICS 4 fracture and establish treatment standards for TLICS 4 fractures. This study included 44 patients with TLICS 4 fracture who initially received nonoperative treatment. We divided these patients into two groups: the successful nonoperative treatment group included 18 patients, and the operative treatment group after nonoperative treatment failure included 26 patients. In multiple logistic regression analysis, spinal canal compromise (odd ratio = 1.316) and kyphotic angle (odd ratio = 1.416) were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Other factors, including age, sex, BMI, initial VAS score, and loss of vertebral body height, were not significantly associated with nonoperative treatment failure in these patients. Spinal canal compromise and kyphotic angle were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Therefore, we recommend the surgeon observe spinal canal compromise and kyphotic angle more carefully when deciding on the treatment of patients with TLICS 4 fracture.

Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis

“…To determine whether this difference is clinically significant, a predetermined MCID of 3.8° was used. Since there is no widely accepted MCID for this variable, an anchor-based method was employed, as described in a 2021 article by Lee et al, 9 which reported that a difference of 3.8° or higher correlated with clinical outcomes. Upon applying this MCID to our analysis, the confidence intervals of the pooled effect estimate of kyphotic angulation were found to include 3.8°, raising doubts about its clinical significance.…”

“…The minimal clinically important difference (MCID) of pain VAS, ODI, RMDQ, and kyphotic angulation were defined as 11, 7 7.8, 7 5, 8 and 3.8°, respectively. 9 …”

“…The minimal clinically important difference (MCID) of pain VAS, ODI, RMDQ, and kyphotic angulation were defined as 11, 7 7.8, 7 5, 8 and 3.8°, respectively. 9 Subsequently, the concepts of the above definitions were used to formulate a search strategy. We searched Medline, EMBASE, Web of Science, and Google Scholar, as illustrated in Figure 1.…”