J Korean Neurosurg Soc.  2015 Mar;57(3):174-177. 10.3340/jkns.2015.57.3.174.

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 HJ
• Kim HS
• Nam KH
• Cho WH
• Choi BK
• Han IH

• KMID: 2191217
• DOI: http://doi.org/10.3340/jkns.2015.57.3.174

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.

Keyword

Thoracolumbar spine trauma; Thoracolumbar injury classification and severity score; Denis's classification; Surgical indication

MeSH Terms

Classification*
Humans
Insurance, Health*
Ligaments
Spine

Figure

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  Fig. 1 Axial CT (A), CT sagittal reconstruction (B), and MR-T2 sagittal (C) showing an T8 burst fracture with lamina fracture in a patient without neurologic deficit. There was no evidence of posterior ligamentous complex (PLC) injury on plain radiographs, CT, or MRI. As a result, this would equal a total Thoracolumbar Injury Classification and Severity Score of 2 (2 points of burst fracture, 0 point of intact neurologic status, 0 of PLC status). We decided to perform surgery because of severe local pain with further kyphotic change and 3 column injured. D and E : The patient underwent posterior T6-10 instrumentation and fusion as seen on plane films. The patient noted back pain improvement and no further kyphotic change after surgical intervention.

Reference

1. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983; 817–831. PMID: 6670016.

2. Joaquim AF, Daubs MD, Lawrence BD, Brodke DS, Cendes F, Tedeschi H, et al. Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients. Spine J. 2013; 13:1760–1765. PMID: 23602328.

3. Joaquim AF, Fernandes YB, Cavalcante RA, Fragoso RM, Honorato DC, Patel AA. Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma. Spine (Phila Pa 1976). 2011; 36:33–36. PMID: 20479700.

4. Joaquim AF, Ghizoni E, Tedeschi H, Batista UC, Patel AA. Clinical results of patients with thoracolumbar spine trauma treated according to the Thoracolumbar Injury Classification and Severity Score. J Neurosurg Spine. 2014; 20:562–567. PMID: 24605999.

5. Lee JY, Vaccaro AR, Lim MR, Oner FC, Hulbert RJ, Hedlund R, et al. Thoracolumbar injury classification and severity score : a new paradigm for the treatment of thoracolumbar spine trauma. J Orthop Sci. 2005; 10:671–675. PMID: 16307197.

6. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994; 3:184–201. PMID: 7866834.

7. McAfee PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine (Phila Pa 1976). 1982; 7:365–373. PMID: 7135069.

8. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976). 1994; 19:1741–1744. PMID: 7973969.

9. Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Br. 1949; 376–394. PMID: 18148776.

10. 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–E110. PMID: 17268253.

11. Raja Rampersaud Y, Fisher C, Wilsey J, Arnold P, Anand N, Bono CM, et al. Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries : a multicenter reliability study. J Spinal Disord Tech. 2006; 19:477–482. PMID: 17021410.

12. Vaccaro AR, Baron EM, Sanfilippo J, Jacoby S, Steuve J, Grossman E, et al. Reliability of a novel classification system for thoracolumbar injuries : the Thoracolumbar Injury Severity Score. Spine (Phila Pa 1976). 2006; 31(11 Suppl):S62–S69. discussion S104. PMID: 16685239.

13. 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; 30:2325–2333. PMID: 16227897.