Retrospective Evaluation Of The TLICS System In Treatment Of Thoracolumbar Spinal Trauma

[Objective]Applications of the TLICS(thoracolumbar injury classification and severity score)score system in the retrospective analysis of the curative effect of the treatment ofthoracolumbar fracture ensured the possibility of evaluating the effectiveness of thetreatment program.[Methods]Since January2008to June2013, the application TLICS system for patients in theFirst Affiliated Hospital of Soochow University and Zhangjiagang City hospitalothoracolumbar fractures score of168cases in which complete data were follow-upstudy.According to the score, patients were divided into the conservative treatment groupand the surgical treatment group. The conservative treatment group was selected frompatients whose TLICS score=4points or TLICS score≤3points. The surgical treatmentgroup has TLICS score≥5points or TLICS score=4points when patients were selected.All patients underwent conventional treatment before thoracolumbar lateral, CTreconstruction and MRI. Statistical analysis was performed by imaging, nerve function andpain, lower back function and return to work in four dimensions to assess the effectivenessof treatment. Standard thoracic and lumbar radiographs were taken for all patients onemonth before the treatment, one month after the treatment, and the last follow-up. Wemeasured vertebral Cobb angles on the lateral X-ray. ASIA grade ratings were used toevaluate the neurological criteria before the treatment and at last the follow-up. The lowerback pain and functional status of the patient in accordance with VAS pain scores andOswestry Disability Index to statistically assess return to work rate of the patient. [Results]All patients have9mounths-6years follow-up record, averaging4.2years, in which96cases were conservative treatments. After one month of treatment, the injured vertebracobb angle recovery from13.45°±2.76°to5.35°±4.51°, the last visit was6.59°±3.65°. VAS score recover from6.88±0.99to3.68±1.16points, last follow-up improved to1.78±0.85points. The ODI value recovery from71.60±4.56to31.92±4.56, the lastvisit was17.51±10.41. In the last visit, the indicators were significantly differentcompared to these indicators before treatment ad statistical significant (P <0.01). Amongwhich, six cases had intractable pain on lower back at the last follow-up. In these lastfollow-ups, patients have return to work rate of92.3%. In the study,72cases were surgicaltreatment. After one month of treatment, cobb angle recover from preoperative21.54°±5.27°to postoperative3.42°±1.98°, last follow-up7.03°±2.71°; VAS score recoverfrom8.38±0.83to3.81±0.71points, the last visit was1.96±0.88points; ODI valuerecovery from83.31±5.20to35.60±11.53, the last visit was20.33±13.77. Theindicators was improved significantly compared with those before last visit and treatment,the results were statistical significant (P <0.01). Last follow-up,5patients with left lowerback pain, nerve function grade A2cases, C grade3cases, D grade7cases, E grade60cases,2cases of paralysis in patients with no improvement, and the remaining patients hadASIA grade1improvement or above. In last follow-up, patients had return to work rate of81.2%.[Conclusion]TLICS score high reliability and repeatability in guiding single segment ofthoracolumbar fractures, simple to use, easy to master, this method for thoracolumbarinjuries more comprehensive and accurate assessment. Can be used as reference for theclinical treatment of patients.