Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Applicability of Thoracolumbar Injury Classification and Severity Score to Criteria of Korean Health Insurance Review and Assessment Service in Treatment Decision of Thoracolumbar Injury

  • Choi, Hyuk Jin (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Kim, Hwan Soo (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Nam, Kyoung Hyup (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Cho, Won Ho (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Choi, Byung Kwan (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Han, In Ho (Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2014.08.05
  • Accepted : 2014.11.18
  • Published : 2015.03.28
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Abstract

Objective : For improving the drawbacks of previous thoracolumbar spine trauma classification, the Spine Trauma Study Group was developed new classification, Thoracolumbar Injury Classification and Severity Score (TLICS). The simplicity of this scoring system makes it useful clinical application. However, considering criteria of Korean Health Insurance Review and Assessment Service (HIRA), the usefulness of TLICS system is still controversial in the treatment decision of thoracolumbar spine injury. Methods : Total 100 patients, who admitted to our hospital due to acute traumatic thoracolumbar injury, were enrolled. In 45, surgical treatment was performed and surgical treatment was decided following the criteria of HIRA in all patients. With assessing of TLICS score and Denis's classification, the treatment guidelines of TLICS and Denis's classification were applied to the criteria of Korean HIRA. Results : According to the Denis's three-column spine system, numbers of patients with 2 or 3 column injuries were 94. Only 45 of 94 patients (47.9%) with middle column injury fulfilled the criteria of HIRA. According to TLICS system, operation required fractures (score>4) were 31 and all patients except one fulfilled the criteria of HIRA. Conservative treatment required fractures (score<4) were 52 and borderline fracture (score=4) were 17. Conclusion : The TLICS system is very useful system for decision of surgical indication in acute traumatic thoracolumbar injury. However, the decision of treatment in TLICS score 4 should be carefully considered. Furthermore, definite criteria of posterior ligamentous complex (PLC) injury may be necessary because the differentiation of PLC injury between TLICS score 2 and 3 is very difficult.

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References

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