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. 2015 Aug 18;10(8):e0135735.
doi: 10.1371/journal.pone.0135735. eCollection 2015.

Risk Factors for the Failure of Spinal Burst Fractures Treated Conservatively According to the Thoracolumbar Injury Classification and Severity Score (TLICS): A Retrospective Cohort Trial

Jieliang Shen  1 , Linfei Xu  2 , Baolong Zhang  2 , Zhenming Hu  1
Affiliations

Risk Factors for the Failure of Spinal Burst Fractures Treated Conservatively According to the Thoracolumbar Injury Classification and Severity Score (TLICS): A Retrospective Cohort Trial

Jieliang Shen et al. PLoS One. .

Abstract

Background: The management of thoracolumbar (TL) burst fractures is still controversial. The thoracolumbar injury classification and severity score (TLICS) algorithm is now widely used to guide clinical decision making, however, in clinical practice, we come to realize that TLICS also has its limitations for treating patients with total scores less than 4, for which conservative treatment may not be optimal in all cases.

Purpose: The aim of this study is to identify several risk factors for the failure of conservative treatment of TL burst fractures according to TLICS algorithm.

Methods: From June 2008 to December 2013, a cohort of 129 patients with T10-l2 TL burst fractures with a TLISC score ≤3 treated non-operatively were identified and included into this retrospective study. Age, sex, pain intensity, interpedicular distance (IPD), canal compromise, loss of vertebral body height and kyphotic angle (KA) were selected as potential risk factors and compared between the non-operative success group and the non-operative failure group.

Results: One hundred and four patients successfully completed non-operative treatment, the other 25 patients were converted to surgical treatment because of persistent local back pain or progressive neurological deficits during follow-up. Our results showed that age, visual analogue scale (VAS) score and IPD, KA were significantly different between the two groups. Furthermore, regression analysis indicated that VAS score and IPD could be considered as significant predictors for the failure of conservative treatment.

Conclusion: The recommendation of non-operative treatment for TLICS score ≤3 has limitations in some patients, and VAS score and IPD could be considered as risk factors for the failure of conservative treatment. Thus, conservative treatment should be decided with caution in patients with greater VAS scores or IPD. If non-operative management is decided, a close follow-up is necessary.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The kyphotic angle (KA) is measured by using the Cobb angle between the superior endplate of the intact vertebra above and the inferior endplate of the intact vertebra below.
The percentages of loss of vertebral body height (LOVBH) and interpedicular distance (IPD) are measured by comparing the anterior body height and IPD with the mean of similar values obtained from the vertebrae immediately above and below. KA = Cobb angle; LOVBH = [(A1 + A2)- 2A0 / (A1 + A2)] × 100%; IPD = [2B0 - (B1 + B2) / (B1 + B2)] × 100%.
Fig 2
Fig 2. Canal compromise (CC) is calculated as a ratio of the canal area of the injured level to the average of that of the two adjacent uninjured segments.
CC = [(C1 + C2)- 2C0 / (C1 + C2)] × 100%.
See this image and copyright information in PMC

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