A New Classification of Thoracolumbar Injuries
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- 15 October 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 30 (20), 2325-2333
- https://doi.org/10.1097/01.brs.0000182986.43345.cb
Abstract
Study Design. A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management. Objective. To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care and surgical treatment approach in unstable injury patterns. Summary of Background Data. The most appropriate classification of traumatic TL spine injuries remains controversial. Systems currently in use can be cumbersome and difficult to apply. None of the published classification schemata is constructed to aid with decisions in clinical management. Methods. Clinical spine trauma specialists from a variety of institutions around the world were canvassed with respect to information they deemed pivotal in the communication of TL spine trauma and the clinical decision-making process. Traditional injury patterns were reviewed and reconsidered in light of these essential characteristics. An initial validation process to determine the reliability and validity of an earlier version of this system was also undertaken. Results. A new classification system called the Thoracolumbar Injury Classification and Severity Score (TLICS) was devised based on three injury characteristics: 1) morphology of injury determined by radiographic appearance, 2) integrity of the posterior ligamentous complex, and 3) neurologic status of the patient. A composite injury severity score was calculated from these characteristics stratifying patients into surgical and nonsurgical treatment groups. Finally, a methodology was developed to determine the optimum operative approach for surgical injury patterns. Conclusions. Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.Keywords
This publication has 12 references indexed in Scilit:
- Surgical Treatment of Traumatic Fractures of the Thoracic and Lumbar SpineSpine, 2004
- Classifications of Thoracic and Lumbar Fractures: Rationale and Supporting DataJournal of the American Academy of Orthopaedic Surgeons, 2002
- A comprehensive classification of thoracic and lumbar injuriesEuropean Spine Journal, 1994
- The Load Sharing Classification of Spine FracturesSpine, 1994
- Classification of Thoracic and Lumbar FracturesSpine, 1994
- La stabilité vertébrale selon la théorie des trois colonnesSurgical and Radiologic Anatomy, 1985
- A Mechanistic Classification of Thoracolumbar Spine FracturesClinical Orthopaedics and Related Research, 1984
- The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal InjuriesSpine, 1983
- Treatment of Lumbodorsal Fracture-DislocationsAnnals of Surgery, 1968
- Note on a type of Flexion Fracture of the SpineThe British Journal of Radiology, 1948