Thoracolumbar Injury Classification And Severity Score System Research Articles

Validation of the TLICS and AOSpine injury score for surgical management of paediatric traumatic spinal injuries

IntroductionFractures of the thoracolumbar spine in children are rare. Consequently, classification systems providing detailed treatment recommendations as already established in adults are still lacking in the paediatric population. We aimed to evaluate the validity and reliability of the thoracolumbar injury classification and severity score system (TLICS) and the AOSpine injury score in paediatric patients presenting with a traumatic fracture of the thoracolumbar spine.Materials and methodsPatients younger than 18 years presenting with a traumatic thoracolumbar fracture at a large academic trauma centre between 2010 and 2020 were included retrospectively. Demographic and clinical data were retrieved from electronic medical reports. The AOSpine injury score and TLICS were calculated using plain radiography, magnetic resonance imaging, and/or computed tomography.ResultsSixty patients with 167 fractures were included. Surgical treatment was performed in 14 patients. The mean AOSpine injury score was 1.49 ± 2.0, the mean TLICS was 1.32 ± 1.65. A significant correlation between the classification systems was found (Spearman r = 0.975, p < 0.001). Interrater reliability analysis revealed Kappa values of 0.868 for the TLICS and 0.860 for the AOSpine injury score (p < 0.001). Contingency table analysis showed a sensitivity of 1.00 and specificity of 0.94 for the AOSpine injury score and a sensitivity of 0.90 and specificity of 0.90 for the TLICS in predicting the performed treatment.ConclusionsOur results confirm that the TLICS is a valid classification system for determining treatment decisions in paediatric patients and show slightly higher accuracy of the AOSpine injury score as well as high interrater reliabilities for both classification systems.

Accuracy of MRI (TLICS vs AOSIS) in assessment of thoracolumbar spine injuries for guiding treatment

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.

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

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.”

Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety.

Study Design Systematic literature review. Objective The Thoracolumbar Injury Classification and Severity Score System (TLICS) is widely used to help guide the treatment of thoracolumbar spine trauma. The purpose of this study is to evaluate the safety of the TLICS in clinical practice. Methods Using the Medline database without time restriction, we performed a systematic review using the keyword “Thoracolumbar Injury Classification,” searching for articles utilizing the TLICS. We classified the results according to their level of evidence and main conclusions. Results Nine articles met our inclusion and exclusion criteria. One article evaluated the safety of the TLICS based on its clinical application (level II). The eight remaining articles were based on retrospective application of the score, comparing the proposed treatment suggested by the TLICS with the treatment patients actually received (level III). The TLICS was safe in surgical and nonsurgical treatment with regards to neurologic status. Some studies reported that the retrospective application of the TLICS had inconsistencies with the treatment of burst fractures without neurologic deficits. Conclusions This literature review suggested that the TLICS use was safe especially with regards to preservation or improvement of neurologic function. Further well-designed multicenter prospective studies of the TLICS application in the decision making process would improve the evidence of its safety. Special attention to the TLICS application in the treatment of stable burst fractures is necessary.

Repeatability of TLICS scoring system used in the thoracolumbar spine injury

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

Low lumbar fractures: does thoracolumbar injury classification and severity score work?

Case series. To investigate if the thoracolumbar injury classification and severity score (TLICS) system is effective in evaluating low lumbar injuries. The TLICS classification has been used by spine traumatologists since its introduction in 2006. The classification is predictable and consistent when dealing with thoracolumbar injuries. It is not known if the classification is effective in dealing with low lumbar injuries that tend to behave differently than thoracolumbar injuries. TLICS is yet to be clinically validated. There are no reports of its use for low lumbar injuries alone. For this case series, 20 low lumbar injuries were graded using the TLICS system by 15 fellowship-trained orthopedic spine and neurosurgeons. Interobserver reliability was graded using κ values. The reviewers were also asked 4 clinical questions regarding diagnosis and treatment of these injuries. When using the TLICS system for low lumbar injuries, there was "fair" reliability among the reviewers. Concerning the final TLICS score, there was 28% agreement with a κ of 0.245. Concerning fracture morphology, there was 58% agreement with a κ value of 0.394. When evaluating the posterior ligamentous complex, there was 56% agreement with a κ value of 0.328. The reviewers did agree consistently on determining the patient's neurological status. The data showed 94% agreement with a κ of 0.818. When looking at L3 injuries by themselves, the reliability of TLICS improved significantly. The authors think that there are factors involved in treating low lumbar injuries that are not inclusive to the TLICS system. Overall, there was only "fair" reliability for low lumbar injuries. The maintenance of lordosis and global sagittal alignment is paramount when dealing with low lumbar injuries and not considered in TLICS. L3 injuries tend to behave like thoracolumbar injuries but there is a wide variation in classification between L4-L5 and thoracolumbar injuries. 4.

The Adoption of a New Classification System

Prospective clinical assessment of the interobserver reliability of the Thoracolumbar Injury Classification and Severity Score (TLISS) in a series of consecutive patients. To evaluate the time-dependent changes in interobserver reliability of the TLISS system. Reliability of an injury classification system is fundamental to its usefulness. A system that can be taught and implemented effectively will be highly reliable. Vaccaro et al recently introduced a novel thoracolumbar injury classification and treatment recommendation system called the "Thoracolumbar Injury Classification and Severity Score." An improvement over previous traumatic thoracolumbar systems, it has been designed to be both descriptive as well as prognostic. To define better the benefits of this system, the purpose of our study was to assess the time-dependent changes associated with implementation of the TLISS system at 1 institution. Seventy-one consecutive patients presenting with acute thoracolumbar injury were prospectively assessed at a single training institution. Plain radiographs, computed tomography, and magnetic resonance imaging were independently reviewed, and each case was classified according to the TLISS system. Seven months later, 25 consecutive patients presenting with acute thoracolumbar injuries were prospectively assessed at the same institution. TLISS classification criteria were again applied after reviewing plain radiographs, computed tomography, and magnetic resonance imaging. The unweighted Cohen kappa coefficient and Spearman correlation values were calculated to assess interobserver reliability at each assessment time. Interobserved reliability at the time of the first assessment was then compared with interobserver reliability from the second assessment. Statistically significant (P < 0.05) improvements in interobserver reliability were observed. Both the unweighted Cohen kappa coefficient and Spearman correlation values increased across all comparable fields: TLISS subscores (mechanism of injury, posterior ligamentous complex), total TLISS, and TLISS management scores. The significant improvements observed in interobserver reliability of the TLISS system suggest that the classification system can be taught effectively and be readily incorporated into daily practice. The strong correlation values obtained at the second assessment time suggest that the TLISS system may be reproducibly used to describe thoracolumbar injuries.