Comparing Management Strategies for Thoracolumbar Injury Classification and Severity Score of 4 (TLICS = 4) in the...

Area of Science:

• Pediatric Orthopedics
• Spine Surgery
• Trauma Management

Background:

• Thoracolumbar (TL) fractures are rare in children.
• The Thoracolumbar Injury Classification and Severity Scale (TLICS) guides treatment, but management for TLICS 4 remains unclear in pediatric patients.
• Existing research primarily focuses on adult populations.

Purpose of the Study:

• To review institutional experience with pediatric TL fractures (TLICS 4).
• To compare outcomes of non-operative and operative management.
• To evaluate the safety and efficacy of different surgical techniques.

Main Methods:

• Retrospective review of pediatric patients (<18 years) with TL fractures and TLICS 4 (2015-2023).
• Analysis of clinical outcomes for patients treated with bracing, minimally invasive screw fixation (MISF), and open posterior screw fixation (OPSF).

Main Results:

• 11 pediatric patients were analyzed.
• Bracing (TLSO) was used for posterior column fractures.
• MISF and OPSF were performed for Chance or posterior column fractures, with MISF showing less blood loss and radiation exposure.
• One case of MISF hardware failure was noted.

Conclusions:

• Bracing and surgical interventions are safe for pediatric TL fractures with TLICS 4.
• MISF is a viable alternative to OPSF, offering advantages in blood loss and radiation.
• Further research with age-matched cohorts and long-term follow-up is needed to establish optimal management.