scholarly journals Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

2020 ◽  
Vol 39 (03) ◽  
pp. 181-188
Author(s):  
Andrei F. Joaquim
Keyword(s):  
Nonoperative Management ◽  
Treatment Options ◽  
Thoracolumbar Spine ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Spine Trauma ◽  
Ligamentous Injury ◽  
Injury Type ◽  
Neurologically Intact ◽  
Injury Classification

Abstract Introduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this review is to discuss the AOSTSIC system and its indications for initial nonoperative versus surgical management of acute TL spine trauma. Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options. Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperative management, with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient. Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

scholarly journals Aneurysmal bone cyst in thoracolumbar spine

2020 ◽  
Vol 6 (3) ◽  
pp. 20190133
Author(s):  
Alex Kiu ◽  
Tiffany Fung ◽  
Pranav Chowdhary ◽  
Sungmi Jung ◽  
Tom Powell ◽  
...  
Keyword(s):  
Treatment Options ◽  
Bone Cyst ◽  
Thoracolumbar Spine ◽  
Cord Compression ◽  
Central Canal ◽  
Neurological Deficits ◽  
Primary Bone Tumors ◽  
Canal Stenosis ◽  
Aneurysmal Bone Cysts ◽  
Primary Bone

Aneurysmal bone cysts (ABC) are rare, benign primary bone tumors. Although benign, they can be locally aggressive resulting in erosion of bone and surrounding tissues over time. In later stages, depending on the clinical urgency, immunotherapy or surgical resection remain treatment options. This report illustrates a case of a 32-year-old female who presented with chronic worsening low back pain without neurological deficits. Radiological imaging revealed a large destructive mass arising from the thoracic spine invading into the central canal, causing critical central stenosis and cord compression. Histopathology revealed ABC. This case highlights the importance of including ABCs and other ‘benign’/locally aggressive lesions in the differential of patients with insidious musculoskeletal complaints. This case also demonstrates that one can be neurologically asymptomatic despite having critical central canal stenosis and cord compression if the causative lesion is slow growing. Understanding this allows us to arrange for most appropriate management.

Predictors of Failure of Nonoperative Management Following Subaxial Spine Trauma and Creation of Modified Subaxial Injury Classification System

2019 ◽  
Vol 122 ◽  
pp. e1359-e1364
Author(s):  
Frederick L. Hitti ◽  
Brendan J. McShane ◽  
Andrew I. Yang ◽  
Cole Rinehart ◽  
Ahmed Albayar ◽  
...  
Keyword(s):  
Classification System ◽  
Nonoperative Management ◽  
Spine Trauma ◽  
Injury Classification

scholarly journals An Independent Inter- and Intraobserver Agreement Evaluation of the New AO Spine Thoracolumbar Spine Injury Classification System

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554440-s-0035-1554440
Author(s):  
Julio Urrutia ◽  
Tomas Zamora ◽  
Ratko Yurac ◽  
Mauricio Campos ◽  
Joaquin Palma ◽  
...  
Keyword(s):  
Classification System ◽  
Thoracolumbar Spine ◽  
Spine Injury ◽  
Intraobserver Agreement ◽  
Injury Classification

scholarly journals Stability of the Subaxial Spine after Penetrating Trauma: Do Classification Systems Apply?

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Jackson Rucker Staggers ◽  
Thomas Elliot Niemeier ◽  
William E. Neway ◽  
Steven Michael Theiss
Keyword(s):  
Severity Score ◽  
Penetrating Trauma ◽  
Adverse Outcomes ◽  
Classification Systems ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Spinal Instability ◽  
Equal Distribution ◽  
Thoracolumbar Injury ◽  
Injury Classification

Objective. Blunt spinal trauma classification systems are well established and provide reliable treatment algorithms. To date, stability of the spine after civilian gunshot wounds (CGSWS) is poorly understood. Herein, we investigate the validity of trauma classification systems including the Thoracolumbar Injury Classification and Severity Score (TLICS), Subaxial Cervical Spine Injury Classification and Severity Score (SLIC), and Denis’ three-column model when applied to spinal penetrating trauma from gunshots, while secondarily evaluating stability of these injuries. Methods. Gunshot injuries to the spine were identified from an institutional database from ICD-nine codes. Trauma scorings systems were applied using traditional criteria. Neurologic compromise and spinal stability were evaluated using follow-up clinic notes and radiographs. Results. Thirty-one patients with CSGSW were evaluated. There was an equal distribution of injuries amongst the spinal levels and spinal columns. Twenty patients had neurological deficits at presentation. Eight patient had a TLICS score >4. Three patients had a SLIC score >4. One patient had surgical treatment. Nonoperative treatment did not lead to spinal instability or adverse outcomes in any cases. The posterior column had a high correlation with neurologic compromise, though not statistically significant (p=.118). Conclusions. The TLICS, SLIC, and three-column classification systems cannot be applied to CSGSW to quantify injury severity, predict outcomes, or guide treatment decision-making. Despite significant neurologic injuries and disruption of multiple spinal columns, CSGSW do not appear to result in unstable injuries requiring operative intervention. Further research is needed to identify the rare spinal gunshot injury that would benefit from immediate surgical intervention.

scholarly journals Establishing the Injury Severity of Thoracolumbar Trauma: Confirmation of the Hierarchical Structure of the AOSpine Thoracolumbar Spine Injury Classification System

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554158-s-0035-1554158
Author(s):  
Gregory Schroeder ◽  
Alexander Vaccaro ◽  
Christopher Kepler ◽  
John Koerner ◽  
Cumhur Oner ◽  
...  
Keyword(s):  
Hierarchical Structure ◽  
Classification System ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Spine Injury ◽  
The Hierarchical Structure ◽  
Injury Classification

Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples

2009 ◽  
Vol 10 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Alpesh A. Patel ◽  
Andrew Dailey ◽  
Darrel S. Brodke ◽  
Michael Daubs ◽  
James Harrop ◽  
...  
Keyword(s):  
Severity Score ◽  
Injury Severity ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Classification Systems ◽  
Spine Trauma ◽  
Injury Characteristics ◽  
Severity Of Injury ◽  
Thoracolumbar Injury ◽  
Injury Classification

Object The aim of this study was to review the Thoracolumbar Injury Classification and Severity Score (TLICS) and to demonstrate its application through a series of spine trauma cases. Methods The Spine Trauma Study Group collaborated to create and report the TLICS system. The TLICS system is reviewed and applied to 3 cases of thoracolumbar spine trauma. Results The TLICS system identifies 3 major injury characteristics to describe thoracolumbar spine injuries: injury morphology, posterior ligamentous complex integrity, and neurological status. In addition, minor injury characteristics such as injury level, confounding variables (such as ankylosing spondylitis), multiple injuries, and chest wall injuries are also identified. Each major characteristic is assigned a numerical score, weighted by severity of injury, which is then summated to yield the injury severity score. The TLICS system has demonstrated initial success and its use is increasing. Limitations of the TLICS system exist and, in some instances, have yet to be addressed. Despite these limitations, the severity score may provide a basis to judge spinal stability and the need for surgical intervention. Conclusions By addressing both the posterior ligamentous integrity and the patient's neurological status, the TLICS system attempts to overcome the limitations of prior thoracolumbar classification systems. The TLICS system has demonstrated both validity and reliability and has also been shown to be readily learned and incorporated into clinical practice.

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