Measuring the impact of the Thoracolumbar Injury Classification and Severity Score among 458 consecutively treated patients

Abstract

Context

The Thoracolumbar Injury Classification and Severity Score (TLICS) was proposed to improve injury classification and guide surgical decision-making of thoracolumbar spinal trauma (TLST), but its impact on the care of patients has not been quantified.

Study design

Retrospective study.

Patient sample

Analysis of 458 patients treated for TLST trauma from 2000 through 2010 at a single center.

Outcome measures

Neurological status – ASIA Impairment Scale (AIS), failure of conservative treatment, and surgical complications.

Methods

Clinical and radiological data were evaluated. Patients were grouped according to the period before (2000–2006) and after (2007–2010) utilization of the TLICS.

Results

From 2000 to 2006, 148 patients were initially treated conservatively (C) and 66 were surgically (S) treated. In the C group, the TLICS ranged from 1 to 7 (median 1; mean 1.57). In the S group, the TLICS ranged from 2 to 10 (median 2; mean 4.14). The TLICS matched treatment in 97.9% of conservatively treated patients. From 2007 to 2010, 162 patients were initially treated C and 82 were treated S. In the C group, the TLICS ranged from 1 to 4 (median 1; mean 1.48). In the S group, the TLICS ranged from 2–10 (median 4; mean 4.4). The TLICS matched treatment in 98.8% of C-treated patients. Overall, failure of C treatment occurred in nine patients; most failures (7/9) and all three missed distractive injuries occurred prior to use of the TLICS.

Conclusions

After introduction of the TLICS, there was a trend towards more successful conservative treatment with fewer conversions to surgical treatment.

Keywords:

• Fractures
• Vertebral
• Burst fractures
• Spinal cord injuries
• Spinal trauma
• Spinal surgery
• Thoracolumbar Injury Classification and Severity Score
• Magerl/AO Spine Classification
• American Spinal Injury Association