Smith Caitlyn J, Abdulazeez Mohanad M, ElGawady Mohamed, Mesfin Fassil B
Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, USA.
Civil, Architectural, and Environmental Engineering, Missouri University of Science and Technology, Rolla, USA.
Cureus. 2021 Jan 2;13(1):e12428. doi: 10.7759/cureus.12428.
This review assesses the validity of a biomechanical approach using finite element analysis in the Thoracolumbar Injury Classification and Severity Score System (TLICS) by addressing the "gray zone" decision discrepancy of thoracolumbar spinal injuries. A systematic review was performed using the keywords "Thoracolumbar Injury Classification" AND "finite element analysis of the spinal column" to evaluate the validity of the TLICS and finite element analysis of the thoracolumbar spinal column. Results were classified according to the main conclusions and level of evidence. Thirteen articles are included. Four of the articles evaluated the TLICS in comparison to other classification systems of thoracolumbar spinal injuries. A notable finding is that the TLICS had inconsistencies with other classification systems in the treatment of burst fractures without neurological deficits. One article evaluated the TLICS with the inclusion of magnetic resonance imaging (MRI) in the evaluation, which decreased the agreement between the suggested and actual treatment. Among the three finite element analysis studies, limited data have been published on the posterior ligamentous complex (PLC) status when an injury is suspected or indeterminate. The TLICS has been a reliable classification system in the management of single-column fractures and three-column injuries treated with surgical stabilization. Special attention to enhancing the TLICS classification system by eliminating the "gray zone" of a TLICS score of 4 is essential. Biomedical computational modeling evaluating the PLC status of indeterminate or injury suspected is needed to enhance the current TLICS system and to clarify the decision discrepancy in the "gray zone."
本综述通过解决胸腰椎损伤的“灰色地带”决策差异，评估了在胸腰椎损伤分类与严重程度评分系统（TLICS）中使用有限元分析的生物力学方法的有效性。使用关键词“胸腰椎损伤分类”和“脊柱的有限元分析”进行了一项系统综述，以评估TLICS的有效性和胸腰椎脊柱的有限元分析。结果根据主要结论和证据水平进行分类。纳入了13篇文章。其中4篇文章将TLICS与其他胸腰椎损伤分类系统进行了比较评估。一个显著发现是，在治疗无神经功能缺损的爆裂骨折时，TLICS与其他分类系统存在不一致。有一篇文章在评估中纳入了磁共振成像（MRI）来评估TLICS，这降低了建议治疗与实际治疗之间的一致性。在三项有限元分析研究中，关于怀疑或不确定存在损伤时后韧带复合体（PLC）状态的已发表数据有限。在处理采用手术稳定治疗的单柱骨折和三柱损伤时，TLICS一直是一个可靠的分类系统。必须特别注意通过消除TLICS评分为4的“灰色地带”来加强TLICS分类系统。需要进行生物医学计算建模来评估不确定或疑似损伤的PLC状态，以改进当前的TLICS系统并澄清“灰色地带”的决策差异。
