Abstract
In order to enhance the reliability of the application to clinical practice of the TLICS classification, we retrospectively reviewed the patients with thoracolumbar spine injuries who underwent magnetic resonance imaging (MRI) and analyzed the validity of the TLICS classification and the necessity of MRI. We enrolled 328 patients with thoracolumbar spine injury who underwent MRI. All patients were classified into conservative and operative treatment groups. The TLICS score of each group was analyzed and the degree of consistent with the recommended treatment through the TLICS classification was examined. Of the total 328 patients, 138 patients were treated conservatively and 190 patients were treated by surgery. Of the 138 patients who underwent conservative treatment, 131 patients (94.9%) had a TLICS score of 4 points or less, and matched with the recommendation score for conservative treatment according to the TLICS classification (match rate 94.9%, 131/138). Of the 190 patients who underwent operative treatment, 160 patients (84.2%) had a TLICS score of 4 points or more (match rate 84.2%, 160/190). All of 30 mismatched patients with a TLICS score of 3 points or less (15.8%) had stable burst fracture without neurological deficit. We retrospectively reviewed the validity of the TLICS classification for the injuries of the thoracolumbar spine, based on MRI in a large group of patients. Treatment with TLICS classification showed high validity, especially in conservative group, and MRI should be an essential diagnostic tool for accurate evaluation of posterior ligamentous complex injury.
Highlights
Vaccaro introduced the TLICS classification in 20053, focusing on neurological deficits and posterior ligamentous complex injuries to overcome the weaknesses of previous classifications
We found that there was a significant correlation between the treatment method selected by clinical practice and the treatment method according to the score of the TLICS classification
We found that it was not easy to determine consistent treatment methods in the past, which did not consider the treatment guidelines according to the TLICS classification, and the preference of the surgeon has a great influence on the treatment plan in our institute
Summary
This report and protocols were approved by the Institutional Review Board of Chonnam National University Hospital. We studied patients with thoracolumbar spine injury who visited our hospital from 2000 to 2016. In thoracolumbar fractures or TLICS classification, MRI is not an essential tool for diagnosis, and it is usually performed at the surgeon’s discretion. In our study, patients who did not have MRI scan were excluded to confirm the validity of TLICS classification more clearly. At the time of treatment, the treatment method was determined according to surgeon’s judgement by referring to MRI, not the TLICS classification. Indication for operative treatment include burst fracture with fifteen degrees or greater kyphosis, loss of more than 50% of anterior vertebral body height, more than 25% of the canal compromised by retropulsed fragment and neurologic deficit in the presence of spinal cord c ompression[7]
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