Clinical Application Analysis of Modified Thoracolumbar Spine Injury Classification Scoring System

Abstract Objective: To propose a modified TLISC system with reference to the Thoracolumbar Injury Classification and Severity Score (TLICS) and prospectively study the feasibility of its guiding clinical treatment. Methods: The study cohort population was 120 patients with thoracolumbar segment fractures admitted to the Department of Spine Surgery of the Sixth Hospital of Ningbo from December 2019 to June 2021, all within one week after fracture, with fracture segments of T11-L2 segments, 68 males and 52 females, aged 22-65 (36.7±5.7) years. The fracture morphology, neurological status, posterior ligament complex (PLC) integrity and disc injury status were combined to assess the fracture severity and formulate clinical treatment strategies based on the total score (T, 0-12 points). The anterior height of the injured spine before and after treatment, the posterior convexity Cobb angle, the VAS score and the spinal nerve function classification and recovery were compared. Results: Based on the scores, 28 cases were finally treated conservatively and 92 cases were treated surgically. Of the 92 surgically treated patients, 8(8.7%) were treated with an anterior approach, 81 (88.0%) with a posterior approach, and 3 (3.3%) with a combined anterior-posterior approach. All patients were followed up for 11 to 27 months [(19.2 ± 4.6) months] after discharge from the hospital. The VAS score at the last follow-up after treatment was 1.94±0.52, the height ratio of the anterior margin of the injured spine was 87.10±7.17%, the sagittal index was 90.35±7.72%, and the Cobb angle was 3.05±0.97 degrees, which were not statistically different from 1 month after treatment (P>0.05) and statistically different from before treatment (P<0.05), and the neurological functional status also had The neurological functional status also improved to different degrees. At the last follow-up, there were 2 cases of broken pedicle screws and no case of broken rods, and 7 cases of pedicle screws with different degrees of wear and cut in the vertebral body, manifesting as mild or severe low back pain. Conclusion: The modified TLICS scoring system is practical in the assessment of thoracolumbar fracture staging and injury degree, and has certain guiding significance for clinical treatment.