A Tool For Guiding Management Of Thoracolumbar Fractures:Evaluation Of The Thoracolumbar Injury Classification And Severity Score(TLISS)

The classification and management of traumatic thoracolumbar spine fractureshas been difficult and controversial. Many thoracolumbar trauma classificationsystems and schemes have been proposed, but a universally accepted and usedreliable classification system is yet to be established. Therefore much emphasisshould be placed on constructing a thoracolumbar spine fracture classificationsystem that accurately describes the sustained injury and reliably guide to suitabletreatment.Objective of this thesis is to analyze the application of a new classification systemfor thoracolumbar fractures and a scale of severity of the injury among spinalsurgeons in regard to predicting the method of treatment. In this dissertation I havebriefly summarized a variety of thoracolumbar injury classification systems andintroduced the use of Thoracolumbar injury classification and severity score (TLISS)system as a guide to assess and provide appropriate treatment in patients whosuffered thoracolumbar injury.Background:TLISS was conceptualized based on a survey of a spine trauma studygroup which consists of an international panel of experts in the field of spine trauma.It is found to be a simple classification system to determine whether a certain patientrequires surgical treatment or not. Extensive research and studies have beenconducted to assess the usefulness of TLISS in the clinical setting and has proved tobe simple and reliable.“TLISS: inter-physician and inter-disciplinary validation of anew paradigm for the treatment of thoracolumbar spine trauma” a study worthmentioning has yielded results demonstrate the use of TLISS to direct treatment ofthoracolumbar spine injuries by physicians of various training levels and specialtieshas moderate agreement in regard to whether these injuries should be treatedsurgically or non-surgically (Kappa values ranging from0.38to0.53, andSpearman’s correlation values ranging from0.40to0.50).[4]Therefore the purpose ofmy study is to understand the use of TLISS system in the clinical setup and establishTLISS as the primary mode of assessment of severity of a thoracolumbar spinal injury to determine whether the patient require operative or non-operative treatment.Method:I have chosen thirty patients who suffered thoracolumbar injuries and hadsurgical intervention to correct the injury in the past year(2012.01-2013.01).Thesepatients were not assessed with the thoracolumbar injury classification and severityscore (TLISS) system prior to surgery. I have used the TLISS system to re-evaluatethese patients and the severity score given is based on，(1)The mechanism of injury(2)The integrity of the posterior ligamentous complex(3) The neurological status of the patientResult:After careful assessment of the patients using TLISS system, twenty sevenpatients out of thirty (90%0had a score of more than5, thus justifying their surgicaltreatment modality. One patient had a TLISS score of4（3.33%）.The remaining twopatients had a score of three or les（6.67%）.Conclusion: In this study out of the thirty patients who had surgery to correct theirinjury, two patients may not have required operative treatment. This means risk andburden of surgery could have been avoided in those two patients had TLISS systembeen used. The advantage of non-operative method of treatment has been to avoidoperative morbidity, such as infection, iatrogenic neurological injury, pseudarthrosis,implant failure and complications of anesthesia.