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

Caitlyn J Smith,Mohanad M Abdulazeez,Fassil B Mesfin,Mohamed Elgawady

doi:10.7759/cureus.12428

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.”

Highlights

BackgroundThoracolumbar (TL) fractures are the most common traumatic injuries to the spinal column
Neurological deficits detected in 18 patients, all received a Thoracolumbar Injury Classification and Severity Score System (TLICS) > 4; 14 patients with incomplete spinal cord injury all received a TLICS score > 4; 8/14 patients received 4 points using the AO system; 37 patients without neurological deficit received < 4 points of TLICS whereas 18/37 patients received 3 AO points, to whom AO recommends conservative treatment they had unstable burst fractures
Compared to AO recommendation, TLICS may be more reliable in guiding surgical management of unstable TL burst fractures without neurological deficits

Summary

Introduction

Thoracolumbar (TL) fractures are the most common traumatic injuries to the spinal column. The annual incidence of TL injures in the United States is approximately 15,000; the majority of those incidents are due to high-energy trauma resulting mainly from a motor vehicle accident in younger patients [1,2]. Nearly 700,000 osteoporotic fractures occur annually in elderly patients [1]. TL injuries occur at the T10 to L2 level [3,4]. The TL junction is more susceptible to injury because there is a transition between the stiff kyphotic thoracic spine and the mobile lordotic lumbar spine [3,4]. 25% percent of TL fractures result in neurological deficit [5,6]

Methods

Results

Conclusion