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Low lumbar fractures: does thoracolumbar injury classification and severity score work?
Timothy A Moore1, Richard J Bransford, John C France
1*Departments of Orthopaedic Surgery and Neurosciences, MetroHealth Medical Center, Cleveland, OH †Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA ‡Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV §Department of Neurosciences, MetroHealth Medical Center, Cleveland, OH ¶Lerner School of Medicine, Cleveland, OH; and ‖Department of Orthopaedic Surgery and Rehabilitation, University of Wisconsin, Madison, WI.
Study Design:
Case series.
Objective:
To investigate if the thoracolumbar injury classification and severity score (TLICS) system is effective in evaluating low lumbar injuries.
Summary Of Background Data:
The TLICS classification has been used by spine traumatologists since its introduction in 2006. The classification is predictable and consistent when dealing with thoracolumbar injuries. It is not known if the classification is effective in dealing with low lumbar injuries that tend to behave differently than thoracolumbar injuries. TLICS is yet to be clinically validated. There are no reports of its use for low lumbar injuries alone.
Methods:
For this case series, 20 low lumbar injuries were graded using the TLICS system by 15 fellowship-trained orthopedic spine and neurosurgeons. Interobserver reliability was graded using κ values. The reviewers were also asked 4 clinical questions regarding diagnosis and treatment of these injuries.
Results:
When using the TLICS system for low lumbar injuries, there was "fair" reliability among the reviewers. Concerning the final TLICS score, there was 28% agreement with a κ of 0.245. Concerning fracture morphology, there was 58% agreement with a κ value of 0.394. When evaluating the posterior ligamentous complex, there was 56% agreement with a κ value of 0.328. The reviewers did agree consistently on determining the patient's neurological status. The data showed 94% agreement with a κ of 0.818. When looking at L3 injuries by themselves, the reliability of TLICS improved significantly.
Conclusion:
The authors think that there are factors involved in treating low lumbar injuries that are not inclusive to the TLICS system. Overall, there was only "fair" reliability for low lumbar injuries. The maintenance of lordosis and global sagittal alignment is paramount when dealing with low lumbar injuries and not considered in TLICS. L3 injuries tend to behave like thoracolumbar injuries but there is a wide variation in classification between L4-L5 and thoracolumbar injuries.
Level Of Evidence:
4.
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