title: Retrospective Analysis of Thoracolumbar Junction Injuries Using the Thoracolumbar Injury Severity and Classification Score, American Spinal Injury Association Class, Injury Severity Score, Age, Sex, and Length of Hospitalization.
abstract: METHODS
  Retrospective review of patient cohort.
  
  
  OBJECTIVE
  Our goal was to assess the validity of the Thoracolumbar Injury Classification and Severity (TLICS) score system by comparing the TLICS system to prior management of thoracolumbar injuries at our institution between January 1, 2006 to March 31, 2011.
  
  
  BACKGROUND
  TLICS was introduced in 2005 to classify and assign treatment recommendations for injuries based on 3 axes: mechanism of injury, integrity of the posterior ligamentous complex, and neurological status.
  
  
  METHODS
  We retrospectively obtained and analyzed patient data regarding thoracolumbar junction injuries at a major academic medical center servicing level I trauma. In addition, we compared the American Spinal Injury Association (ASIA) class at time of injury to last follow-up to determine if there was any change in neurological status after intervention. We also compared sex, injury severity score (ISS), length of hospitalization, and age between nonoperatively and operatively treated patients.
  
  
  RESULTS
  Included in our study were 201 patients (70% male and 30% female). We found the TLICS system agreed with prior thoracolumbar junction injury management at our institution 98% of the time in nonoperatively treated patients and 78% of the time in operatively treated patients. Age, sex, and ISS were not statistically significant factors in patients who were treated operatively versus nonoperatively, however, there was a trend towards higher ISS in operatively treated patients. Average TLICS score between nonoperative and operative groups was 1.56 and 4.8, respectively, and was a statistically significant difference. There was no statistically significant difference in ASIA class improvement between operative and nonoperative treatment, however, this is likely because of having only 20 patients in this subcohort. Of note, about 50% of the 17 operatively treated patients had improvement in ASIA class.
  
  
  CONCLUSIONS
  Our data suggest that TLICS is a valuable tool in a spine surgeon's armamentarium in treating thoracolumbar junction injuries. Some surgeons might be more likely to operate on thoracolumbar junction injuries that should be treated nonoperatively according to the TLICS score. As with all classification schemes, the TLICS system should be used in conjunction with sound clinical judgment.
authors.affiliation: Department of Orthopaedics, The Ohio State University Medical Center, Columbus, OH.
authors.forename: Shah-Nawaz M
authors.initials: SN
authors.lastname: Dodwad
authors.forename: Shah-Jahan M
authors.initials: SJ
authors.lastname: Dodwad
authors.forename: Ronald
authors.initials: R
authors.lastname: Wisneski
authors.forename: Safdar N
authors.initials: SN
authors.lastname: Khan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008022:Ligaments / Q000473:pathology; D008136:Longevity; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013124:Spinal Injuries / Q000145:classification* / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000473:pathology; D016896:Treatment Outcome