title: Clinical results of patients with thoracolumbar spine trauma treated according to the Thoracolumbar Injury Classification and Severity Score.
abstract: OBJECTIVE
  The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed to improve injury classification and guide surgical decision making, yet validation remains necessary. This study evaluates the neurological outcome of patients with thoracolumbar spine trauma (TLST) treated according to the TLICS.
  
  
  METHODS
  The TLICS was prospectively applied to a consecutive series of patients treated for TLST between 2009 and 2012. Patients with a TLICS of 4 points or more were surgically treated, whereas patients with a TLICS of 3 points or fewer were conservatively managed. The primary outcome was the American Spinal Injury Association Impairment Scale (AIS).
  
  
  RESULTS
  A total of 65 patients were treated. In 37 patients, the TLICS was 3 points or fewer and the patients were treated nonsurgically (Group 1). The remaining 28 patients with a TLICS of 4 or more points underwent surgical treatment (Group 2). In Group 1, 28 patients underwent some follow-up at the authors' institution; all of these patients were neurologically intact with compression or burst fractures (TLICS of 1 or 2 points; median 2). The average age in this group was 44.5 years, and follow-up ranged from 1 to 36 months (mean 6.7 months, median 3 months). Two patients (both with a TLICS of 2 points) underwent late surgery for axial back pain and mild focal kyphosis, without significant clinical improvement. In Group 2, follow-up ranged from 1 to 18 months (mean 4.4 months, median 3 months) and the TLICS ranged from 4 to 10 points (median 7 points). In this group, preoperatively, 9 (32%) patients had AIS Grade E injuries, 6 (21%) had AIS Grade C, 1 (4%) had AIS Grade B, and 12 (43%) had AIS Grade A injuries. At the final follow-up, the AIS grade was E in 11 patients (39%), D in 5 (18%), and A in 12 (43%). No patient had neurological worsening during the follow-up.
  
  
  CONCLUSIONS
  The TLICS can be used to guide treatment that is safe with regard to the neurological status of patients treated for TLST.
authors.affiliation: Division of Neurosurgery, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; and.
authors.forename: Andrei F
authors.initials: AF
authors.lastname: Joaquim
authors.forename: Enrico
authors.initials: E
authors.lastname: Ghizoni
authors.forename: Helder
authors.initials: H
authors.lastname: Tedeschi
authors.forename: Ulysses Caus
authors.initials: UC
authors.lastname: Batista
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013124:Spinal Injuries / Q000145:classification* / Q000000981:diagnostic imaging / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome