Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital Neurologique Et Neurochirurgical Pierre Wertheimer, 69003, Lyon, France.
Université de Lyon, Université Claude Bernard, 69008, Lyon, France.
Eur Spine J. 2021 Oct;30(10):3036-3042. doi: 10.1007/s00586-020-06681-4. Epub 2021 Jan 21.
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.
胸腰椎骨折是儿童最常见的脊柱损伤类型。可能发生多种类型的脊柱损伤，因此已制定了用于管理这些患者的治疗算法。目前，胸腰椎损伤分类和严重程度评分系统（TLICS）和胸腰椎 AOSpine 损伤评分（AOSpine 评分）旨在提供治疗建议。我们旨在评估 TLICS 评分和 AOSpine 评分系统在儿童中的可靠性，并确定一种评分方法的优势，以将其在儿科脊柱创伤的常规临床管理中推广应用。
对 2006 年至 2019 年间连续入住 1 级创伤中心的创伤性胸腰椎骨折的儿童进行回顾性病历审查。我们将我们在儿童脊柱创伤的临床实践中进行的治疗与基于 TLICS 和 AOSpine 评分的决策算法进行了比较。根据这些评分，当 TLICS 评分≥5 且 AOSpine 评分>5 时，应进行手术治疗；当 TLICS 评分=4 且 AOSpine 评分=4 或 5 时，手术或保守治疗是合理的。手术指征基于临床状况、骨折解剖结构和生长脊柱矢状失平衡的风险。
54 名患者符合纳入标准。我们证明，AOSpine 评分和 TLICS 评分对脊柱创伤的手术治疗决策均具有显著相关性（p<0.0001）。我们发现，儿科临床实践中的手术决策与 TLICS 评分具有高度一致性。在我们的儿科队列中，TLICS 评分≥5 的患者明显多于 AOSpine 评分>5 的患者（n=47，87%比 n=26，46%，p<0.0001）。TLICS 评分≥4 的患者明显多于 AOSpine 评分≥4 的患者（n=53，98%比 n=42，77%，p=0.001）。结论：TLICS 评分明显优于 AOSpine 评分，适用于儿童的手术治疗决策，尤其是在考虑未来矢状失平衡风险时。
