Epidemiology of Thoracolumbar Spine Injuries associated with Speedboat Travelling without Collision: A Unique Spine Injury Mechanism.

Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to classifying thoracolumbar injuries within the spinal community, but there remains a need to classify, evaluate and manage thoracolumbar fractures. This article aims to provide a guide on classification of thoracolumbar spine injuries using the AO Spine Thoracolumbar Injury Classification System (AO TLICS).

Retrospective Cohort Study. To determine how historical management of thoracolumbar spine injuries compares to the recently proposed AO Spine Thoracolumbar Injury Classification System treatment algorithm. Classifications of the thoracolumbar spine are not uncommon. The frequent advent of new classifications is typically due to previous classifications being primarily descriptive or unreliable. Thus, AO Spine created a classification with an associated treatment algorithm to guide injury classification and management. Thoracolumbar spine injuries were retrospectively identified from a prospectively collected spine trauma database at a single, urban, academic medical center during the years 2006 to 2021. Each injury was classified and assigned points based on the AO Spine Thoracolumbar Injury Classification System injury severity score. Patients were grouped into scores of 3 or less (preferred initial conservative treatment) and greater than 6 (preferred initial surgical intervention). Either operative or non-operative treatment was considered appropriate for injury severity scores of 4 or 5. A total of 815 patients (TL AOSIS 0-3: 486, TL AOSIS 4-5: 150, TL AOSIS 6+: 179) met inclusion status. Injury severity scores of 0-3 were more likely to undergo non-operative management compared to scores of 4-5 or 6+ (99.0% vs. 74.7% vs. 13.4%, P <0.001). Thus, guideline congruent treatment was 99.0%, 100%, and 86.6%, respectively ( P <0.001). Most injuries determined to be a 4 or 5 were treated non-operatively (74.7%). Based on the treatment algorithm, 97.5% of patients who received operative treatment and 96.1% who received non-operative treatment were managed in accordance with the algorithm. Of the 29 patients who did not receive algorithm congruent treatment, 5 (17.2%) were treated surgically. A retrospective review of thoracolumbar spine injuries at our urban academic medical center identified that patients are historically treated in accordance with the proposed AO Spine Thoracolumbar Injury Classification System treatment algorithm.

To compare the treatment recommendations of the thoracolumbar injury classification and severity score system and the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score in case of thoracolumbar spine injury. The cross-sectional study was conducted at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from July to December 2023, and comprised patients aged at least 18 irrespective of gender, who had traumatic thoracic and lumbar vertebral spine fractures. Data regarding age, gender, mode of trauma, findings of neurological examination and imaging was collected. All cases were independently scored by an experienced spine surgeon, and a radiologist provided standardised imaging interpretation. The scorers were blinded to clinical outcomes and treatment decisions. Interrater agreement between thoracolumbar injury classification and severity score system and the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score was assessed using Cohen's kappa coefficient. Data was analysed using SPSS 23. Of the 335 patients with mean age 32.24±13.32 years, 279(83.3%) were males. The most common mode of trauma was fall from height 189(56.4%), and the most common site of fracture was L1 vertebrae 109(32.5%). Based on the thoracolumbar injury classification and severity score system, the most common fracture morphology was burst fracture 257(76.7%). The most common fracture type based on the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score was Type A compression injuries 300(89.6%). The thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score had more patients in the grey zone 30(9%) compared to thoracolumbar injury classification and severity score system 22(6.6%). Treatment recommendations were the same in both the classification systems for 306(91.3%) patients (Cohen's kappa = 0.812, p<0.001). There was no significant difference between the treatment recommendations suggested by the thoracolumbar injury classification and severity score system and the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score. The differences in grey zone classification highlighted the complexity of thoracolumbar injury assessment.

Online questionnaire survey. To obtain the opinion of experts on whether the currently available classification systems for thoracolumbar and subaxial cervical spine injuries meet their expectations with regard to the desired objectives of a good classification system and practical implementability. An online survey was conducted during August-September 2013 using a specially designed questionnaire. Members of Spine Trauma Study Group of International Spinal Cord Society and other spinal injury experts were approached, and responses were analyzed. Forty-two spine experts responded. Majority (87.50%, n=35) were involved with education and research. For subaxial cervical spine injuries, Allen Ferguson classification was more commonly used (37.50%, n=15) and thought to be practically implementable in day-to-day practice (30.77%). For thoracolumbar injuries, while Thoracolumbar Injury Classification and Severity Score (TLICS) was more commonly used (47.50%, n=19), the response of experts for practical implementability in day-to-day practice was more evenly distributed among TLICS, AO (Association for Osteosynthesis) and Dennis classifications (30.77, 23.08 and 25.64%, respectively). Experts felt that the classification systems did not serve all the desired objectives. The reliability for residents was especially a concern. We may still be far from an ideal classification system. Many experts continue to prefer or would consider shifting back to traditional and simpler systems. There is a need for developing classification systems that would be better implementable practically in day-to-day clinical practice, better guide treatment, be more reliable, incorporate other modifiers influencing treatment and be more comprehensive in that order of priority.

BackgroundThe thoracic segment represents the most common area fractured in the whole spine. Complete neurological deficits are commonly associated with thoracic injuries possibly due to a relatively small canal diameter as compared to the cervical or lumbar spine. Magnetic resonance is the gold standard of imaging, especially in patients suffering from neurological deficits as well as in soft tissue assessment mainly the disc, ligaments, and neural elements. The thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AO Spine injury score (TLAOSIS), are two scoring systems designed to help surgeons in management plans of thoraco-lumbar injuries. The aim of our study is to compare these two main thoracolumbar injury classification systems in deciding the management strategies in thoraco-lumbar injuries. This study is a retrospective study that included 70 patients (42 males and 28 females) who suffered acute traumatic vertebral fractures. All patients underwent MRI including T1WI, T2W and STIR sequences. The MRI was viewed by two independent radiologists of 5- and 10-years’ experience and compared to surgical decisions.ResultsOut of 70 patients included in our study, the TL AOSIS matched treatment recommendation in 62 patients (88.6%), and the TLICS matched in 60 patients (85.7%). The TL AOSIS achieved sensitivity 95%, specificity 80%, while the TLICS achieved sensitivity 72.2%, specificity 100%.ConclusionBoth TL AOSIS and TLICS have very close results in their reliability for guiding treatment strategy, yet TL AOSIS matched treatment recommendation more than TLICS, with sensitivity more than TLICS, while TLICS had more specificity.

Introduction: Majority of the traumatic spine injuries are located at the thoracolumbar region. They can be compression fractures, burst fractures, flexionextension injuries (Chance fractures), dislocations, or any of the combination. Surgery is indicated for patients with thoracolumbar injury classification scoring (TLICS) of 4 or more. Traditionally, surgical approaches for thoracolumbar spinal injuries involve open surgery, instrumentation with/without decompression. In our previous study, open surgery for traumatic thoracolumbar injuries and history of blood transfusion have been found to be associated with higher risk of deep surgical site infection requiring surgical debridement. With the advent of modern implants and equipments, minimally invasive surgery (MIS) has been made possible for spine surgeries. We report our two-year experience in utilizing MIS to treat traumatic thoracolumbar spinal injuries. Materials and method: Patients who underwent spinal surgeries at Hospital Tengku Ampuan Afzan, Kuantan from July 2017 to July 2019 were screened for suitability to be included in this study. Only patients who underwent spinal minimally invasive surgeries have been included in this study. Patients who underwent open spinal surgeries were excluded. Results: A total of 8 patients were included in this study. There were 3 burst fractures and 5 chance fractures. All patients underwent a minimum of 4-level posterior spinal instrumented fusion with MIS techniques and 2 patients had laminectomy at the injured level for decompression. All but one patient did not require blood transfusion and there was no incidence of surgical site infection among these patients. Conclusion: Minimally invasive surgery (MIS) is a better option compared to open surgery in treating traumatic thoracolumbar spinal injuries. By minimizing the surgical incision, we are able to reduce blood loss and avoid deep surgical site infection.

Objective To evaluate the thoracolumbar injury severity score [ thoracolumbar injury classifica-tion and severity score（TLICS）]and repeatability,and analyze its clinical significance in the treatment of injury of thoracolumbar.Methods The clinical and imaging data of our hospital （thoracolumbar X ray,CT examination,MRI examination） of intact thoracolumbar fractures in 90 patients were retrospectively analyzed ,respectively,TLICS score were made for their site of spinal injury morphology ,neural function and the posterior ligament complex three .Three months after reviewed ,TLICS was analyzed by using Cohen weighted kappa coefficient score .Its repeatability was ana-lyzed.Results According to the TLICS system ,spinal injury body ,nerve function and the integrity of the posterior ligamentous complex were evaluated , respectively, the repeatability coefficient of Kappa , the calculated total to 0.47 non operation group,operation group,the total score was 0.46,with a moderate consistency.The neural function evaluation of the highest high consistency ,consistency .No significant differences between the two groups of repetitive Kappa coefficient（statistical values =0.674 5,P〉0.05）.According to the TLICS system of statistical accuracy ,the diagnostic sensitivity,specificity ratios was 95.8%,86.4%,97.6%,respectively.Conclusion The reliability of TLICS system for thoracolumbar treatment and recovery is higher ,relative comprehensive evaluation ,which can effec-tively guide the clinical treatment . Key words: Spinal injuries; Repeatability,results; Kappa coefficient; Thoracolumbar injury classification and severity score system

Objective To summarize the thoracolumbar injuries and treatment in children and adolescents. Methods Since 2000, clinical data, surgical methods, efficacy and mechanism of 177 children and adolescents with thoracolumbar spine injury treated in Honghui Hospital of Xi'an Jiaotong University School of Medicine were analyzed and compared.Treatment was in accordance with easy typing method of Honghui Hospital of Xi'an Jiaotong University School of Medicine.The principles and systematic methods of analysis of such damage was emphasized.Clinical, physiological and psychological effects were observed. Results According to easy typing method of Honghui Hospital of Xi'an Jiaotong University School of Medicine.Ⅰa-c 77 cases, Ⅱa 40 cases.Twenty-seven cases of Frankel A were unchanged.There were 28 cases that had been restored to Frankel C in 30 cases of Frankel B. There were 2 cases that had been restored to Frankel D in 30 cases of Frankel B. There were 2 cases that had been restored to Frankel D in 27 cases of Frankel C. There were 25 cases that had been restored to Frankel E in 27 cases of Frankel C. There were 30 cases that had been restored to Frankel E in 30 cases of Frankel D. In 177 patients, imaging, VAS, ODI, SF-36, DPQ, MMSE, Barthel and psychology had achieved significant differences before and after treatment for follow-up of 7-12 months(all P<0.05). Conclusions Simple type is easy to grasp.It applies to children and adolescents treatment of thoracic and lumbar spine injury to good effect.It is a reasonable treatment strategy. Key words: Thoracolumbar spine injury; Spinal cord injury; Child; Adolescent

Aim:Recently, AOSpine trauma knowledge forum proposed the AOSpine thoracolumbar injury classification (AOSTLIC) system and suggested that it was reliable. However, reliability data from additional institutions for the AOSTLIC system are not available. This study was to examine the reliability of the AOSTLIC system in patients with thoracolumbar (TL) fractures.Materials and Methods:Between August 2009 and June 2012, 56 patients with 74 levels traumatic TL spinal injuries were recruited. Two classifiers, consisting of two spine surgeons, assessed clinical and imaging data. Initially, one surgeon reviewed the data in order to classify and calculate injury severity score according to the AOSTSIC system. This process was repeated on a 5-week interval by another surgeon. Then we analyzed data for intra-observer and inter-observer reliability using the kappa statistic (k). Finally, validity was assessed using the known-groups comparison.Results:The mean age of patients was 59.5 ± 11.5 years. The κ values for the AOSTSIC system for intra-observer and inter-observer reliability ranged from 0.83 to 0.89, indicating nearly perfect agreement agreements. Known-groups analysis showed satisfactory results. The AOSTSIC system discriminated well between sub-groups of patients who differed in Oswestry disability index.Conclusion:The findings showed that the morphologic classification in AOSTSIC system appears to be reliable and reproducible classification.

Thoracolumbar Evaluation in the Low-Risk Trauma Patient: A Pilot Study Towards Development of a Clinical Decision Rule to Avoid Unnecessary Imaging in the Emergency Department.

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury.Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group.There were 22 males and 8 females, aged 17 -74 ( mean, 47 ) years, with duration between 7 - 36 ( mean, 18) months.There were nineteen cases of thoracolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group.We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group.They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury.The urodynamic findings of the two groups were comparable.SPSS 16.0 was used to compare the differences between the groups by ANOVA/rank sum test.Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups.The maximum free flow rate was ( 13.0 ±5.1 ) vs ( 13.0 ±5.8) ml/s, the free flow rate at 2 s was (6.5 ±5.1 ) vs (6.9 ±6.4) ml/s, the mean free flow rate was (5.4± 2.4) vs ( 3.4 ± 0.5 ) ml/s, urine output volume was ( 279.1 ±131.1 ) vs (450.0 ± 26.6) ml and the residual urine volume was (209.5 ± 180.7 ) vs (434.0 ± 215.0) ml.The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group (P ＜ 0.05).We also measured the the cystometric parameters.The maximum urinary flow rate was (16.0±23.3) vs (7.1 ±3.3) ml/s, average flow rate was (4.6 ±2.3) vs (3.9 ± 2.3) ml/s, the flow rate after voiding 2 s was (4.6 ± 3.1 ) vs (2.2 ± 3.2) ml/s, urine output volume was (268.4 ± 113.9) vs ( 129.0 ± 97.9) ml, detrusor pressure of maximum flow rate was (58.8 ± 22.0) vs (56.5 ± 14.5) cm H2 O, flow rate of maximum detrusor pressure was (4.8 ± 2.0) vs (4.8 ± 4.4) ml/s,the maximum detrusor pressure was (68.0 ± 31.0) vs (54.6 ± 20.2) cm H2O and the average pressure of voiding period was (47.4 ±20.0) vs (42.6 ± 13.9) cm H2O.The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group ( P ＜ 0.05 ).There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group (P ＞ 0.05).The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients (4/11) was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients (11/19) was higherthan the thoracolumbar group.Conclusions The urodynamics' difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes.Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the cidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher. Key words: Urodynamics; Spinal cord injury; Voiding dysfunction

Objective This study aimed to assess the reliability and reproducibility of the AO Spine Thoracolumbar Injury Classification System by using virtual reality (VR). We hypothesized that VR is a highly reliable and reproducible method to classify traumatic spine injuries. Methods VR 3D models were created from CT scans of 26 pediatric patients with thoracolumbar spine injuries. Seven orthopedic trainees were educated on the VR platform and AO Spine Thoracolumbar Injury Classification System. Classifications were summarized by primary class and subclass for both rater readings performed two weeks apart with image order randomized. Intra-observer reproducibility was quantified by Fleiss's kappa (kF) for primary classifications and Krippendorff's alpha (aK) for subclassifications along with 95% confidence intervals (CIs) for each rater and across all raters. Inter-observer reliability was quantified by kFfor primary classifications and aKfor subclassifications along with 95% CIs across all raters for the first read, the second read, and all reads combined. The interpretations were as follows: 0-0.2: slight; 0.2-0.4: fair; 0.4-0.6: moderate; 0.6-0.8: substantial; and >0.8: almost perfect agreement. Results A total of 364 classifications were submitted by seven raters. Intra-observer reproducibility ranged from moderate (kF=0.55) to almost perfect (kF=0.94) for primary classifications and from substantial (aK=0.68) to almost perfect (aK=0.91) for subclassifications. Reproducibility was substantial across all raters for the primary class (kF=0.71; 95% CI=0.61-9.82) and subclass (aK=0.79; 95% CI=0.69-0.86). Inter-observer reliability was substantial (kF=0.63; 95% CI=0.57-0.69) for the first read, moderate (kF=0.58; 95% CI=0.52-0.64) for the second read, and substantial (kF=0.61; 95% CI=0.56-0.65) for all reads for primary classifications. For subclassifications, inter-observer reliability was substantial (aK=0.74; 95% CI=0.58-0.83) for the first read, second read (aK=0.70; 95% CI=0.53-0.80), and all reads (aK=0.72; 95% CI=0.60-0.79). Conclusions Based on our findings, VR is a reliable and reproducible method for the classification of pediatric spine trauma, besides its ability to function as an educational tool for trainees. Further research is needed to evaluate its application for other spine conditions.

While most motor vehicle crash (MVC)-related injuries have been decreasing, one study showed increases in MVC-related spinal fractures from 1994 to 2002 in Wisconsin. To our knowledge, no studies evaluating nationwide trends of MVC-related thoracolumbar spine injuries have been published. Such fractures can cause pain, loss of functionality or even death. If the incidence of such injuries is increasing, it may provide a motive for reassessment of current vehicle safety design. We questioned whether the incidence of thoracolumbar spine injuries increased in the United States population with time (between 1998 and 2011), and if there was an increased incidence of thoracolumbar injuries, whether there were identifiable compensatory "trade-off injury" patterns, such as reductions in sacropelvic injuries. Institutional review board approval was obtained for retrospective review of three national databases: the National Trauma Databank® (NTDB®), 2002-2006, National Automotive Sampling System (NASS), 2000-2011, and National Inpatient Sample (NIS), 1998-2007. In each database, the total number of MVC-related injuries and the number of MVC-related thoracolumbar injuries per year were identified using appropriate Abbreviated Injury Scale (AIS) or ICD-9 codes. Sacropelvic injuries also were identified to evaluate their potential as trade-off injuries. Poisson regression models adjusting for age were used to analyze trends in the data with time. All databases showed increases in MVC-related thoracolumbar spine injuries when adjusting for age with time. These age-adjusted relative annual percent increases ranged from 8.22% (95% CI, 5.77%-10.72%; p<0.001) using AIS of 2 or more (AIS2 +) injury codes in the NTDB®, 8.59% (95% CI, 5.88%-11.37%; p<0.001) using ICD-9 codes in the NTDB®, 8.12% (95% CI, 7.20%-9.06%; p<0.001) using ICD-9 codes in the NIS, and 8.10 % (95% CI 5.00%-11.28%; p<0.001) using AIS2+ injury codes in the NASS. As these thoracolumbar injuries have increased, there has been no consistent trend toward a compensatory reduction in terms of sacropelvic injuries. While other studies have shown that rates of many MVC-related injuries are declining with time, our data show increases in the incidence of thoracolumbar injury. Although more sensitive screening tools likely have resulted in earlier and increased recognition of these injuries, it cannot be stated for certain that this is the only driver of the increased incidence observed in this study. As seatbelt use has continued to increase, this trend may be the result of thoracolumbar injuries as trade-offs for other injuries, although in our study we did not see a compensatory decrease in sacropelvic injuries. Investigation evaluating the root of this pattern is warranted.

Retrospective review of charts and fluoroscopic, radiographic, and computed tomography images for 252 screws (41 patients). To describe a fluoroscopically assisted technique of thoracic pedicle screw insertion and to determine the technique's safety, short-term complications, and accuracy. Pedicle screw instrumentation is safe and effective for lumbar spine stabilization, but evidence of its accuracy and complications in the thoracic spine is lacking. Between 1997 and 2000, 41 consecutive patients with unstable cervicothoracic, thoracic, and thoracolumbar spine injuries were admitted to a regional, level 1 trauma center. These patients underwent posterior spine arthrodesis and pedicle screw instrumentation placed intraoperative multiplanar fluoroscopic imaging. Pedicle screw placement accuracy was determined by review of postoperative computed tomography scans. Instrumentation failure prevalence was determined by review of fluoroscopic images, postoperative radiographs, and computed tomography scans. Neurologic, infectious, vascular, and gastrointestinal complications were determined by review of operative reports, hospital records, and clinic notes. Of the 126 (50%) thoracic screws (22 patients) with postoperative computed tomography scans, 16 (12.7%) penetrated the pedicle cortex (4 [2.4%] medially and 13 [10.3%] laterally) and 7 (5.6%) penetrated the vertebral body. There were four surgical complications: one instrumentation failure (broken rod, no loss of correction), one deep infection, and two superficial infections. The infections resolved with irrigation, debridement, and intravenous antibiotics. During the 6- to 24-month follow-up period, there were no neurologic, vascular, or gastrointestinal complications. Cervicothoracic, thoracic, and thoracolumbar spine injuries can be managed safely and effectively with thoracic pedicle screws inserted under multiplanar fluoroscopic imaging.

Introduction: This study aimed to evaluate the value of the modified Thoracolumbar Injury Classification and Severity Score (mTLICS) in diagnosing and guiding the treatment of thoracolumbar spine injuries at Phu Tho Provincial General Hospital. It also compared mTLICS with TLICS and TL AOSIS systems in predicting surgical and conservative treatment decisions. Subjects and Methods: A retrospective study was conducted on 41 patients with thoracolumbar spine injuries from January to April 2025. All patients underwent a 3.0 Tesla MRI. Their injuries were classified using TLICS, TL AOSIS and mTLICS. The classification results were compared with treatment decisions to assess sensitivity, specificity, and accuracy. Results: mTLICS showed superior diagnostic performance with 89% sensitivity, 100% specificity, and 93% accuracy (based on the second reader). Inter-rater agreement was moderate to substantial (Kappa = 0.708 for fracture morphology and 0.8 for posterior ligamentous injury). The mTLICS also highly correlated with surgical decision-making (r = 0.779 and 0.755). Notably, it achieved the highest area under the ROC curve (AUROC: 0.939–0.95), compared to TLICS (0.855–0.874) and TL AOSIS (0.802–0.843). At a cutoff score &gt;3, mTLICS reached 92–100% sensitivity and 81.25% specificity. Conclusion: mTLICS is a reliable and accurate classification system for thoracolumbar injuries, offering better predictive value than TLICS and TL AOSIS. Its implementation may enhance decision-making and treatment outcomes, especially in provincial hospitals.