title: 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?
abstract: OBJECTIVE
  To determine whether the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Arbeitsgemeinschaft für 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Erzurum Regional Training and Research Hospital, Department of Neurosurgery, Erzurum, Turkey.
authors.forename: Mehmet Onur
authors.initials: MO
authors.lastname: Yuksel
authors.forename: Mehmet Sabri
authors.initials: MS
authors.lastname: Gurbuz
authors.forename: Merih
authors.initials: M
authors.lastname: Is
authors.forename: Hakan
authors.initials: H
authors.lastname: Somay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072700:Conservative Treatment; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D018529:Nutritional Support; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D057832:Watchful Waiting; D055815:Young Adult