DOI QR코드

DOI QR Code

Non-Operatively Treated Thoracolumbar Burst Fracture with Posterior Ligamentous Complex Injury: Case Report and Consideration on the Limitation of Thoracolumbar Injury Classification and Severity (TLICS) Score

  • Kwon, Woo-Keun (Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Oh, Jong-Keon (Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Cho, Jun-Min (Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kwon, Taek-Hyun (Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Park, Youn-Kwan (Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Moon, Hong Joo (Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kim, Joo Han (Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine)
  • Received : 2018.06.02
  • Accepted : 2018.07.31
  • Published : 2018.08.31

Abstract

Fractures at the thoracolumbar region are commonly followed after major traumatic injuries, and up to 20% of these fractures are known to be burst fractures. Making surgical decisions for these patients are of great interest however there is no golden standard so far. Since the introduction of Thoracolumbar Injury Classification and Severity (TLICS) score in 2007, it has been widely used as a referential guideline for making surgical decisions in thoracolumbar fractures. However, there is still limitations in this system. In this clinical case report, we introduce a L1 burst fracture after motor vehicle injury, who was successfully treated conservatively even while she was graded as a TLICS 5 injury. A case report is presented as well as discussion on the limitations of this grading system.

Keywords

References

  1. Bensch FV, Koivikko MP, Kiuru MJ, Koskinen SK. The incidence and distribution of burst fractures. Emerg Radiol 2006;12:124-9. https://doi.org/10.1007/s0010140-005-0457-5
  2. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries:the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 2005;30:2325-33. https://doi.org/10.1097/01.brs.0000182986.43345.cb
  3. Patel AA, Dailey A, Brodke DS, Daubs M, Harrop J, Whang PG, et al. Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity score system and case examples. J Neurosurg Spine 2009;10:201-6. https://doi.org/10.3171/2008.12.SPINE08388
  4. Patel AA, Vaccaro AR, Albert TJ, Hilibrand AS, Harrop JS, Anderson DG, et al. The adoption of a new classification system: time-dependent variation in interobserver reliability of the thoracolumbar injury severity score classification system. Spine (Phila Pa 1976) 2007;32:E105-10. https://doi.org/10.1097/01.brs.0000254107.57551.8a
  5. Harrop JS, Vaccaro AR, Hurlbert RJ, Wilsey JT, Baron EM, Shaffrey CI, et al. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005. J Neurosurg Spine 2006;4:118-22. https://doi.org/10.3171/spi.2006.4.2.118
  6. Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976) 2006;31:2881-90. https://doi.org/10.1097/01.brs.0000247804.91869.1e
  7. Mattei TA, Hanovnikian J, H Dinh D. Progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the Achilles tendon of the Thoracolumbar Injury Classification and Severity score (TLICS). Eur Spine J 2014;23:2255-62. https://doi.org/10.1007/s00586-014-3312-0
  8. Schnake KJ. Expert's comment concerning grand rounds case entitled "progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the Achilles tendon of the Thoracolumbar Injury Classification and Severity score (TLICS)" (T.A. Mattei, J. Hanovnikian, D. Dinh). Eur Spine J 2014;23:2263-4. https://doi.org/10.1007/s00586-014-3591-5
  9. Schnake KJ, Stavridis SI, Kandziora F. Five-year clinical and radiological results of combined anteroposterior stabilization of thoracolumbar fractures. J Neurosurg Spine 2014;20:497-504. https://doi.org/10.3171/2014.1.SPINE13246
  10. Bailey CS, Urquhart JC, Dvorak MF, Nadeau M, Boyd MC, Thomas KC, et al. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J 2014;14:2557-64. https://doi.org/10.1016/j.spinee.2013.10.017
  11. Shen J, Xu L, Zhang B, Hu Z. Risk factors for the failure of spinal burst fractures treated conservatively according to the Thoracolumbar Injury Classification and Severity score (TLICS): a retrospective cohort trial. PLoS One 2015;10:e0135735. https://doi.org/10.1371/journal.pone.0135735