The Adoption of a New Classification System

Patel, Alpesh A.; Vaccaro, Alexander R.; Albert, Todd J.; Hilibrand, Alan S.; Harrop, James S.; Anderson, D. Greg; Sharan, Ashwani; Whang, Peter G.; Poelstra, Kornelius A.; Arnold, Paul M.; Dimar, John R.; Madrazo, Ignacio; Hegde, Sajan

doi:10.1097/01.brs.0000254107.57551.8a

Cited by 88 publications

(23 citation statements)

References 6 publications

(1 reference statement)

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“…If that score is greater than 5 points, the operative treatment is suggested. This TLISS showed fair to substantial (kappa, 0.24-0.724) intraobserver and interobserver reliability in several studies [ 33 , 34 , 35 ]. However, many surgeons tended to classify the same type of injury differently because this classification classified fractures based on the mechanism of injury.…”

Section: Discussionmentioning

confidence: 83%

Treatment of Thoracolumbar Fracture

2015

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The most common fractures of the spine are associated with the thoracolumbar junction. The goals of treatment of thoracolumbar fracture are leading to early mobilization and rehabilitation by restoring mechanical stability of fracture and inducing neurologic recovery, thereby enabling patients to return to the workplace. However, it is still debatable about the treatment methods. Neurologic injury should be identified by thorough physical examination for motor and sensory nerve system in order to determine the appropriate treatment. The mechanical stability of fracture also should be evaluated by plain radiographs and computed tomography. In some cases, magnetic resonance imaging is required to evaluate soft tissue injury involving neurologic structure or posterior ligament complex. Based on these physical examinations and imaging studies, fracture stability is evaluated and it is determined whether to use the conservative or operative treatment. The development of instruments have led to more interests on the operative treatment which saves mobile segments without fusion and on instrumentation through minimal invasive approach in recent years. It is still controversial for the use of these treatments because there have not been verified evidences yet. However, the morbidity of patients can be decreased and good clinical and radiologic outcomes can be achieved if the recent operative treatments are used carefully considering the fracture pattern and the injury severity.

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Section: Discussionmentioning

confidence: 83%

Treatment of Thoracolumbar Fracture

2015

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“…Many reports have described controversies about treatment for thoracolumbar and lumbar fractures, due to the high frequency of these injuries and the differences in the severity of instability [1,2,21]. Three approaches are available for the surgical treatment of thoracic and lumbar burst fracture, using anterior, posterior, or combined methods.…”

Section: Discussionmentioning

confidence: 99%

“…Three approaches are available for the surgical treatment of thoracic and lumbar burst fracture, using anterior, posterior, or combined methods. No ideal procedure exists, due to the wide variety of clinical and radiological features present in indivisual cases [1,2,21,22]. …”

Section: Discussionmentioning

confidence: 99%

Anterior Decompression and Shortening Reconstruction with a Titanium Mesh Cage through a Posterior Approach Alone for the Treatment of Lumbar Burst Fractures

et al. 2012

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Study DesignA retrospective study.PurposeTo examine the efficacy and safety for a posterior-approach circumferential decompression and shortening reconstruction with a titanium mesh cage for lumbar burst fractures.Overview of LiteratureSurgical decompression and reconstruction for severely unstable lumbar burst fractures requires an anterior or combined anteroposterior approach. Furthermore, anterior instrumentation for the lower lumbar is restricted through the presence of major vessels.MethodsThree patients with an L1 burst fracture, one with an L3 and three with an L4 (5 men, 2 women; mean age, 65.0 years) who underwent circumferential decompression and shortening reconstruction with a titanium mesh cage through a posterior approach alone and a 4-year follow-up were evaluated regarding the clinical and radiological course.ResultsMean operative time was 277 minutes. Mean blood loss was 471 ml. In 6 patients, the Frankel score improved more than one grade after surgery, and the remaining patient was at Frankel E both before and after surgery. Mean preoperative visual analogue scale was 7.0, improving to 0.7 postoperatively. Local kyphosis improved from 15.7° before surgery to -11.0° after surgery. In 3 cases regarding the mid to lower lumbar patients, local kyphosis increased more than 10° by 3 months following surgery, due to subsidence of the cages. One patient developed severe tilting and subsidence of the cage, requiring additional surgery.ConclusionsThe results concerning this small series suggest the feasibility, efficacy, and safety of this treatment for unstable lumbar burst fractures. This technique from a posterior approach alone offers several advantages over traditional anterior or combined anteroposterior approaches.

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“…The LSC and TLICS scores accurately reflect the severity of the injury. The inclusion of this critical clinical variable likely accounts for the high rate of agreement between the TLICS score and historical surgical cohorts 20. TLICS and severity scores are easily applied and have been shown to match prior surgical indications while having the advantage of being able to systematize those indications.…”

Section: Discussionmentioning

confidence: 99%

Posterior Ligamentous Complex Injuries Are Related to Fracture Severity and Neurological Damage in Patients with Acute Thoracic and Lumbar Burst Fractures

et al. 2013

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PurposeThe proposed the thoracolumbar injury classification system (TLICS) for thoracolumbar injury cites the integrity of the posterior ligamentous complex (PLC). However, no report has elucidated the severity of damage in thoracic and lumbar injury with classification schemes by presence of the PLC injury. The purpose of this study was to accurately assess the severity of damage in thoracic and lumbar burst fractures with the PLC injuries.Materials and MethodsOne hundred consecutive patients treated surgically for thoracic and lumbar burst fractures were enrolled in this study. There were 71 men and 29 women whose mean age was 36 years. Clinical and radiologic data were investigated, and the thoracolumbar injury classification schemes were also evaluated. All patients were divided into two groups (the P group with PLC injuries and the C group without PLC injuries) for comparative examination.ResultsFourth-one of 100 cases showed PLC injuries in MRI study. The load sharing classification score was significantly higher in the P group [7.8±0.2 points for the P group and 6.9±1.1 points for the C group (p<0.001)]. The TLICS (excluded PLC score) score was also significantly higher in the P group [6.2±1.1 points for the P group and 4.0±1.4 points for the C group (p<0.001)].ConclusionThe presence of PLC injury significantly influenced the severity of damage. In management of thoracic lumbar burst fractures, evaluation of PLC injury is important to accurately assess the severity of damage.

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The Adoption of a New Classification System

Cited by 88 publications

References 6 publications

Treatment of Thoracolumbar Fracture

Treatment of Thoracolumbar Fracture

Anterior Decompression and Shortening Reconstruction with a Titanium Mesh Cage through a Posterior Approach Alone for the Treatment of Lumbar Burst Fractures

Posterior Ligamentous Complex Injuries Are Related to Fracture Severity and Neurological Damage in Patients with Acute Thoracic and Lumbar Burst Fractures

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