Gonzales-Portillo Gabriel S, Mamaril-Davis James C, Riordan Katherine, Avila Mauricio J, Aguilar-Salinas Pedro, Burket Aaron, Dumont Travis
Medicine, The University of Arizona College of Medicine, Tucson, USA.
Neurosurgery, The University of Arizona College of Medicine, Tucson, USA.
Cureus. 2023 Aug 19;15(8):e43762. doi: 10.7759/cureus.43762. eCollection 2023 Aug.
Introduction The use of the Thoracolumbar Injury Classification and Severity Score (TLICS) and other classification systems for guiding the management of traumatic spinal injuries remains controversial. TLICS is one of the few classifications that provides treatment recommendations.We sought to analyze intervention modality selection based on the TLICS scoring system. Methods A retrospective review of patients presenting with traumatic thoracolumbar fractures at a level 1 trauma center over a two-year period was performed. Primary endpoints for comparison analysis included visual analog scale (VAS) scores and Cobb angles during follow-up. Results There were 272 patients with thoracolumbar fractures, of whom 212 had TLICS of ≤3, six with TLICS of 4, and 54 with TLICS of ≥5. Of the 272 total patients, 59 were treated via surgery and 213 via non-surgical conservative methods. The VAS scores significantly decreased from presentation to last follow-up in both surgically treated and conservative groups (p<0.0001). This remained consistent in subgroup analyses of TLICS ≤ 3, TLICS = 4, and TLICS ≥ 5 (p<0.0001). Burst fractures treated conservatively had larger fracture Cobb angles versus those treated via surgery at the last follow-up, although this was not significantly associated (p=0.07). The only significant relationship with Cobb angles was in distraction fractures of the TLICS > 4 conservative group, who had significantly lower Cobb angles at the last follow-up than the TLICS > 4 surgical group (p<0.04). The "surgeon's choice" for TLICS = 4 was surgical intervention (4/6 patients, 66.7%). Conclusion Using the TLICS score, thoracolumbar injuries in a level 1 trauma center are more commonly TLICS ≤ 3. For patients with TLICS = 4, the surgeon's choice was most commonly surgical repair. VAS scores decreased over time from presentation between surgically and conservatively managed patients (as well as within-group analyses). The data concerning Cobb angles were more ambiguous, as larger Cobb angles in burst fractures treated conservatively did not show statistically significant differences with surgery.
引言 胸腰椎损伤分类与严重程度评分（TLICS）及其他分类系统在指导创伤性脊柱损伤的治疗方面仍存在争议。TLICS是少数提供治疗建议的分类方法之一。我们试图基于TLICS评分系统分析干预方式的选择。方法 对一家一级创伤中心在两年期间收治的创伤性胸腰椎骨折患者进行回顾性研究。比较分析的主要终点包括随访期间的视觉模拟量表（VAS）评分和Cobb角。结果 共有272例胸腰椎骨折患者，其中212例TLICS评分≤3，6例TLICS评分为4，54例TLICS评分≥5。在272例患者中，59例接受手术治疗，213例采用非手术保守治疗方法。手术治疗组和保守治疗组的VAS评分从就诊到最后一次随访均显著降低（p<0.0001）。在TLICS≤3、TLICS = 4和TLICS≥5的亚组分析中也是如此（p<0.0001）。在最后一次随访时，保守治疗的爆裂骨折患者的骨折Cobb角大于手术治疗患者，尽管差异无统计学意义（p = 0.07）。与Cobb角唯一显著相关的是TLICS>4的保守治疗组的牵张性骨折，其在最后一次随访时的Cobb角显著低于TLICS>4的手术治疗组（p<0.04）。TLICS = 4的“外科医生选择”是手术干预（4/6例患者，66.7%）。结论 使用TLICS评分，一级创伤中心的胸腰椎损伤更常见的是TLICS≤3。对于TLICS = 4的患者，外科医生最常选择手术修复。手术和保守治疗患者（以及组内分析）从就诊到随访期间VAS评分均随时间下降。关于Cobb角的数据更不明确，因为保守治疗的爆裂骨折患者较大的Cobb角与手术治疗相比未显示出统计学显著差异。
