The Thoracolumbar Injury Classification and Severity Score Appropriately Predicts Treatment in Children Aged 10 and Under.

Retrospective cohort study. This study aims to assess the validity of the Thoracolumbar Injury Classification and Severity Score (TLICS) in patients ≤10 years-old. TLICS is a validated measure developed to help facilitate clinical decision-making regarding thoracolumbar spinal trauma in adults. Studies examining the utility of TLICS in children skew towards older pediatric patients, where the spine's biomechanical properties are more similar to adults. Due to differences in a pre-adolescent spine compared to a more mature, adolescent spine, it is unclear if TLICS can be applied to younger patients. A single center spine trauma registry was queried for patients ≤10 with an acute, traumatic thoracolumbar fracture treated at a level-1 pediatric trauma center between 2006 and 2020. Test characteristics and Receiver-Operator Curve were used to evaluate TLICS based on TLICS <4=nonsurgical treatment and TLICS >4=surgery recommendation. We identified 94 patients with traumatic thoracolumbar fractures (surgical=20; non-surgical=74). Despite TLICS-suggested operative management in 28 patients with TLICS>4, 9 (32.1%) were initially treated non-operatively. All patients who deviated from TLICS-suggested treatment had flexion-distraction injuries (FDI). Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 89.2%, 70.4%, and 100%, respectively. The receiver operating characteristic curve demonstrated strong diagnostic ability of TLICS in predicting need for surgery (area under the curve: 0.97, F1-score: 0.86). TLICS score <4 showed strong validity and is highly specific in predicting non-operative management for patients ≤10 years-old with thoracolumbar fractures. However, TLICS >4 has more limited specificity in indicating the necessity for surgical intervention, as many FDIs were successfully treated without surgery. Additional factors other than TLICS score may need to be considered for these more severe injuries to optimize management in this age group.

Metcalf T ，Paulson AE ，Sborov KD ，Moore-Lotridge SN ，Schoenecker JG ，Mencio GA ，Martus JE ，Louer CR Jr ... -  《-》

Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population.

Thoracolumbar fractures are the most common kind of spine injury in children. Several types of spine injury can occur, and for this reason, treatment algorithms have been put in place for the management of these patients. At present, the thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AOSpine injury score (AOSpine score) aimed at providing treatment recommendations. We aimed to assess the reliability, in children, of the TLICS scoring and AOSpine scoring systems, and to define the superiority of one of the methods of scoring, to spread its use in routine clinical management in the pediatric spine trauma. A retrospective chart review of consecutive children admitted to a Level 1 trauma center for traumatic thoracolumbar fractures, between 2006 and 2019, was performed. We compared the management we performed in clinical practice in children with spine trauma, to the decisional algorithms based on the TLICS and AOSpine scores. According to these scores, surgical treatment should be performed when the TLICS score ≥ 5 and the AOSpine score > 5; and surgical or conservative treatment was considered reasonable when the TLICS score = 4 and the AOSpine score = 4 or 5. Surgical indications were based on the clinical status, the anatomy of the fracture, and the risk of sagittal imbalance of the growing spine. Fifty-four patients met the inclusion criteria. We demonstrated that both the AOSpine score and the TLICS scores had a significant correlation for surgical management decision of spine trauma (p < 0.0001). We found a high concordance between surgical decision making in the pediatric clinical practice and the TLICS score. In our pediatric cohort, there were significantly more patients with TLICS ≥ 5 (n = 47, 87%) than with AOSpine score > 5 (n = 26, 46%, p < 0.0001). There were significantly more patients with TLICS ≥ 4 (n = 53, 98%), than with AOSpine score ≥ 4 (n = 42, 77%, p = 0.001). ConclusionsThe TLICS score was significantly more appropriate than the AOSpine score, for the surgical treatment decision in children, especially when considering the future risk of sagittal imbalance.

Dauleac C ，Mottolese C ，Beuriat PA ，Szathmari A ，Di Rocco F ... -  《-》

The Reliability and Validity of the Thoracolumbar Injury Classification System in Pediatric Spine Trauma.

Savage JW ，Moore TA ，Arnold PM ，Thakur N ，Hsu WK ，Patel AA ，McCarthy K ，Schroeder GD ，Vaccaro AR ，Dimar JR ，Anderson PA ... -  《-》

Thoracolumbar Injury Classification and Severity Score in Children: A Validity Study.

The Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a valid tool for assessing the need for surgical intervention in adult patients. There is limited insight into its usefulness in children. To assess the validity of the TLICS system in pediatric patients. The medical records for pediatric patients with acute, traumatic thoracolumbar fractures at two Level 1 trauma centers were reviewed retrospectively. A TLICS score was calculated for each patient using computed tomography and magnetic resonance images, along with the neurological examination recorded in the patient's medical record. TLICS scores were compared with the type of treatment received. Receiver operating characteristic (ROC) curve analysis was employed to quantify the validity of the TLICS scoring system. TLICS calculations were completed for 165 patients. The mean TLICS score was 2.9 (standard deviation ± 2.7). Surgery was the treatment of choice for 23% of patients. There was statistically significant agreement between the TLICS suggested treatment and the actual treatment received (P < 0.001). The ROC curve calculated using multivariate logistic regression analysis of the TLICS system's parameters as a tool for predicting treatment demonstrated excellent discriminative ability, with an area under the ROC curve of 0.96, which was also statistically significant (P < 0.001). The TLICS system demonstrates good validity for selecting appropriate thoracolumbar fracture treatment in pediatric patients.

Dawkins RL ，Miller JH ，Menacho ST ，Ramadan OI ，Lysek MC ，Kuhn EN ，Tubbs RS ，Walker ML ，Walters BC ，Agee BS ，Rozzelle CJ ... -  《-》

Retrospective Analysis of Thoracolumbar Junction Injuries Using the Thoracolumbar Injury Severity and Classification Score, American Spinal Injury Association Class, Injury Severity Score, Age, Sex, and Length of Hospitalization.

Dodwad SN ，Dodwad SJ ，Wisneski R ，Khan SN ... -  《-》