The Effect of Thoracolumbar Injury Classification in the Clinical Outcome of Operative and Non-Operative Treatments

Abstract

This review assesses the validity of a biomechanical approach using finite element analysis in the Thoracolumbar Injury Classification and Severity Score System (TLICS) by addressing the “gray zone” decision discrepancy of thoracolumbar spinal injuries. A systematic review was performed using the keywords “Thoracolumbar Injury Classification” AND “finite element analysis of the spinal column” to evaluate the validity of the TLICS and finite element analysis of the thoracolumbar spinal column. Results were classified according to the main conclusions and level of evidence. Thirteen articles are included. Four of the articles evaluated the TLICS in comparison to other classification systems of thoracolumbar spinal injuries. A notable finding is that the TLICS had inconsistencies with other classification systems in the treatment of burst fractures without neurological deficits. One article evaluated the TLICS with the inclusion of magnetic resonance imaging (MRI) in the evaluation, which decreased the agreement between the suggested and actual treatment. Among the three finite element analysis studies, limited data have been published on the posterior ligamentous complex (PLC) status when an injury is suspected or indeterminate. The TLICS has been a reliable classification system in the management of single-column fractures and three-column injuries treated with surgical stabilization. Special attention to enhancing the TLICS classification system by eliminating the “gray zone” of a TLICS score of 4 is essential. Biomedical computational modeling evaluating the PLC status of indeterminate or injury suspected is needed to enhance the current TLICS system and to clarify the decision discrepancy in the “gray zone.”

Short segment versus long segment pedicle screws fixation in management of thoracolumbar burst fractures

“…Postoperative complications: Regards to postoperative complications, CSF leakage occurs in only one patient of short segment fixation group (3.3%) versus two patients of long segment fixation group (6.7%), also new neurological deficit occurs in only two patients of short segment fixation group (6.7%) versus three patients of long segment fixation group (10%) of insignificant difference between two studied groups (p=0.571). A 10-year follow-up study by Toyone et al [18] suggested that the benefit of short-segment fixation for burst fractures involving neurological deficit is that it can preserve thoracolumbar motion without resulting in post-traumatic disc degeneration.…”

Thoracolumbar spine trauma: a guide for the FRCS examination

“…Posterior Ligamentous Complex (PLC) integrity 3. Patient's neurological status TLICS relies on X-ray, CT and magnetic resonance imaging (MRI) and provides a management algorithm (Table 1) that still requires the experienced judgement of spine surgeons to make a decision in many cases [11,12]. TLICS fails to consider the vitally important patient-specific modifiers in tailoring the management plan to individual patients [10,13].…”

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

“…While operative treatment is typically preferred for severe fractures with posterior ligamentous complex injury or neurological deficit, nonoperative treatment is usually preferred for minor fractures with minimal bone injuries [4]. However, the TLICS system has a major drawback when it comes to deciding the treatment for patients with TLICS 4 fracture [6][7][8]. The best treatment for thoracolumbar fracture patients with moderate injury of TLICS 4 remains the surgeon's choice [9,10].…”