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.
Highlights
Thoracolumbar fracture is one of the most common injuries that cause neurological damage
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]
Our study showed that patients with thoracolumbar injury classification and severity score (TLICS) 4 fracture may require operative treatment if they have severe spinal canal compromise (SCC) and kyphotic angle (KA) deformity after the injury
Summary
Thoracolumbar fracture is one of the most common injuries that cause neurological damage These are mostly the result of trauma caused by traffic accidents or falling from heights [1,2,3]. They account for approximately 15–20% of all spine injuries [4,5]. The main goal of these fracture classification systems is to establish a reliable universal criterion for dividing thoracolumbar fractures. Among these classification systems, the TLICS system is frequently used by spine surgeons to categorize thoracolumbar fractures and devise appropriate therapeutic strategies.
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