Turkish Neurosurgery 2018 , Vol 28 , Num 1
Is the Thoracolumbar Injury Classification and Severity Score (TLICS) Superior to the AO Thoracolumbar Injury Classification System for Guiding the Surgical Management of Unstable Thoracolumbar Burst Fractures without Neurological Deficit?
Mehmet Onur YUKSEL1,Mehmet Sabri GURBUZ2,Merih IS3,Hakan SOMAY3
1Erzurum Regional Training and Research Hospital, Department of Neurosurgery, Erzurum, Turkey
2Safa Hospital, Department of Neurosurgery, Istanbul, Turkey
3Haydarpasa Numune Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.19094-16.2 AIM: To determine whether the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Arbeitsgemeinschaft fr Osteosynthesefragen (AO) Spine Thoracolumbar Injury Classification System have any superiority to each other regarding the reliability of their recommendations in the surgical management of unstable thoracolumbar burst fractures.

MATERIAL and METHODS: Fifty-five consecutive patients with thoracolumbar burst fractures undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. TLICS and AO systems were compared based on patients" American Spinal Injury Association (ASIA) scores and they were analyzed for their safety and reliability.

RESULTS: A total of 55 patients were studied. Neurological deficits were detected in 18 patients and the remaining 37 patients had normal neurological functions. All the patients with neurological deficits received >4 points according to TLICS. There were 14 patients with incomplete spinal cord injury and all of them received >4 points according to TLICS (p<0.01). On the other hand; 8 of these 14 patients received 4 points according to the AO system. None of the 37 patients without neurological deficit received <4 points of TLICS whereas 18 of these 37 patients received 3 AO points, to whom AO recommends conservative treatment despite the fact that they had unstable burst fractures (p<0.01).

CONCLUSION: Recommendations of TLICS might be more reliable than those of AO particularly for guiding the surgical management of unstable thoracolumbar burst fractures without neurological deficit. However, this conclusion needs to be verified with further multicenter prospective studies. Keywords : Thoracolumbar injury, Thoracolumbar burst fracture, Thoracolumbar injury classification and severity score, AOSpine thoracolumbar injury classification system

Corresponding author : Mehmet Onur YUKSEL, dr.onur_yksl@hotmail.com