Modified thoracolumbar injury classification and severity score (TLICS) and its clinical usefulness.

Thoracolumbar injury classification and severity score (TLICS) is not very reliable for assessment of injury to the posterior ligament complex, even when scored by experts. It is not reasonable to score every compression fracture or burst fracture the same as there is great variety in the severity of compression fractures and burst fractures. To propose a modified TLICS (mTLICS) and evaluate the performance of the mTLICS system by measuring the agreement between scores determined by radiologists using both systems and actual treatment procedure delivered. We retrospectively evaluated 134 patients with acute lumbar and thoracic spinal trauma after undergoing magnetic resonance imaging (MRI) using new mTLICS and conventional TLICS system. Inter-observer agreements of TLICS and mTLICS scores were analyzed using the kappa statistic. Nonparametric correlation analysis was used to determine correlation (R) among each score and the surgical intervention. The mTLICS system showed slightly higher correlation than TLICS (Rs, TLICS, 0.592 and 0.613 vs. mTLICS, 0.628 and 0.639). If we consider a total maximal score of 4 to be a negative surgical indication, mTLICS showed significantly higher sensitivities than TLICS, and if we consider a total minimal score of 4 to be a positive surgical indication, mTLICS showed significantly higher specificities than TLICS. The mTLICS score corrects deficiencies in the TLICS system that lead to ambiguity in the radiological diagnostic criteria. mTLICS is a more suitable scoring system than TLICS for predicting surgical management accurately, especially for morphological injuries.

Park HJ ，Lee SY ，Park NH ，Shin HG ，Chung EC ，Rho MH ，Kim MS ，Kwon HJ ... -  《-》

Thoracolumbar Injury Classification and Severity Score in children: a reliability study.

Dawkins RL ，Miller JH ，Ramadan OI ，Lysek MC ，Kuhn EN ，Rocque BG ，Conklin MJ ，Tubbs RS ，Walters BC ，Agee BS ，Rozzelle CJ ... -  《-》

Thoracolumbar Injury: The Thoracolumbar Injury Classification and Severity Scoring System or Modified Thoracolumbar Injury Classification and Severity?

To compare the Thoracolumbar Injury Classification and Severity (TLICS) scoring system with its modified (mTLICS) version based on their agreement with the surgeon's opinion regarding treatment for patients with thoracolumbar injuries. Moreover, the Posterior Ligamentous Complex health was compared between intraoperative examinations and magnetic resonance imaging (MRI) reports. MRI was obtained from 114 patients suffering thoracolumbar spinal trauma; the TLICS and mTLICS scores were measured. Approaches 1 and 2 were designed in both scoring systems based on assuming a total score of 4 as surgery and conservative management indication, respectively. Kappa was used to estimate the agreements between each approach and the surgeon's opinion on treatment. The receiver operating curve calculated the appropriate cut-off scores for the above systems over which surgical management was preferred. A P < 0.05 was considered significant. All the approaches showed moderate agreements with the surgeon's opinion on therapeutic management (TLICS: κapproach1 = 0.557, κapproach2 =0.508; mTLICS: κapproach1 = 0.557, κapproach2 = 0.551; P < 0.001 for each κ). A score >3.5 best illustrated the indication for surgery in both systems. The radiology report agreed stronger with intraoperatively observed ligamentous health when suspicious cases on MRI were reported as injured (κTLICS = 0.830, κmTLICS = 0.704) rather than healthy (κTLICS = 0.620, κmTLICS = 0.620). The surgeon's treatment plan agreed moderately with suggestions of the TLICS and mTLICS systems; surgery was the preferred management for the patients with a score of 4. Moreover, radiologic suspicion of Posterior Ligamentous Complex injury seemed to indicate a damaged ligament rather than a healthy one.

Hajiahmadi S ，Rezvani M ，Fahimitabar S ，Rasti S ... -  《-》

Reliability of the thoracolumbar injury classification and severity score and comparison with the denis classification for injury to the thoracic and lumbar spine.

Lewkonia P ，Paolucci EO ，Thomas K 《-》

Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients.

The Thoracolumbar Injury Classification System (TLICS) system has been developed to improve injury classification and guide surgical decision-making, yet validation of this new system remains sparse. This study evaluates the use of the TLICS in a large, consecutive series of patients. This is a retrospective case series. A total of 458 patients treated for thoracic or lumbar spine trauma between 2000 and 2010 at a single, tertiary medical center were included in this study. American Spinal Injury Association (ASIA) status and crossover from conservative to surgical treatment were measured. Clinical and radiological data were evaluated, classifying the injuries by ASIA status, the Magerl/AO classification, and the TLICS system. A total of 310 patients (67.6%) was treated conservatively (group 1) and 148 patients (32.3%) were surgically (group 2) treated. All patients in group 1 were ASIA E, except one (ASIA C). In this group, 305 patients (98%) had an AO type A fracture. The TLICS score ranged from 1 to 7 (mean 1.53, median 1). A total of 307/310 (99%) patients matched TLICS treatment recommendation (TLICS≤4), except three with distractive injuries (TLICS 7) initially misdiagnosed. Nine patients (2.9%) were converted to surgical management. In group 2, 105 (70.9%) were ASIA E, whereas 43 (29%) had neurological deficits (ASIA A-D). One hundred and three patients (69.5%) were classified as AO type A, 36 (24.3%) as type B, and 9 (6%) as type C. The TLICS score ranged from 2 to 10 (mean 4.29, median of 2). Sixty-nine patients (46.6%) matched the TLICS recommendation; all discordant patients (53.4%) were treated for stable burst fractures (TLICS=2). No neurological complications occurred in either group. The TLICS recommendation matched treatment in 307/310 patients (99%) in the conservative group. However, in the surgical group, 53.4% of patients did not match TLICS recommendations, all were burst fractures without neurological injury (TLICS=2). The TLICS system can be used to effectively classify thoracolumbar injuries and guide conservative treatment. Inconsistencies, however, remain in the treatment thoracolumbar burst fractures.

Joaquim AF ，Daubs MD ，Lawrence BD ，Brodke DS ，Cendes F ，Tedeschi H ，Patel AA ... -  《-》