Introduction: The most common injury patterns in thoracolumbar spine trauma are compression and burst fractures, most without neurologic deficit. TLICS was created to aid in treatment decision making.
Methods: Delayed operation rate for increasing pain or kyphosis was analyzed in a large group (N=142, from a prospective registry between 2006 and 2010), suffering acute thoracolumbar compression or burst fracture without neurologic injury. Attention was paid to TLICS classification, injury level, and time to delayed surgery.
Results: Thirty-five patients were TLICS1, all initially treated non-operatively. Two (5.7%) required delayed operations. Fifty-five were TLICS2, 72.7% initially treated conservatively. Four (10%) required delayed surgery. No patients were TLICS3. Thirty-seven were TLICS4, 12 (32.4%) initially treated conservatively. Three (25%) required delayed surgery. TLICS5 had 15 patients, one (6.7%) treated conservatively. None required delayed surgery. The most common level injured in patients who required delayed surgery was L1 (5 patients). Other levels involved included T11, T12, L2, and T8. One-third had consecutive injured levels. Delayed surgery was performed at an average of 6 months after the injury (range 1-18 months). Eight (88.9%) had surgery within 9 months, and 5 (55.6%) within 4 months.
Conclusions: Delayed operation rate is much higher in TLICS4 compared to TLICS1 or TLICS2. This trend towards, without reaching, significance is due to the small number of TLICS4 patients that were initially treated conservatively. Injury at the thoracolumbar junction carries the highest risk of the need for delayed operation. The rate of surgery is greatest within nine months of injury. This analysis supports the recommendation of initial conservative management of TLICS1 and 2, but suggests stronger consideration be given to surgical management of TLICS4 acute thoracolumbar compression or burst fractures in neurologically intact patients.
Patient Care: This research adds further data and guidance in the decision making of how to treat acute compression and burst fractures in the thoracolumbar spine.
Learning Objectives: By the conclusion of this session participants should be able to: 1) Classify neurologically intact patients with acute compression and burst fractures into TLICS categories, 2) Have further understanding which of these patients warrant strong initial surgical consideration, and 3) Identify which patients are at greatest risk for needing delayed surgery after initially conservative management of the fracture.
References: Lee JY et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci. 2005 Nov;10(6):671-5.