OUTCOME OF CONSERVATIVE MANAGEMENT OF DORSOLUMBAR SPINE FRACTURES WITH THORACOLUMBAR INJURY CLASSIFICATION AND SEVERITY SCORE FOUR IN TERMS OF NEUROLOGY, KYPHOTIC ANGULATION AND PAIN

Muhammad Aamir; Zia Ur Rehman; Syed Shayan Shah; Muhammad Sohaib Khan; Adnan Khan; Syed Jawad Ahmad

doi:10.46903/gjms/23.4.2089

OUTCOME OF CONSERVATIVE MANAGEMENT OF DORSOLUMBAR SPINE FRACTURES WITH THORACOLUMBAR INJURY CLASSIFICATION AND SEVERITY SCORE FOUR IN TERMS OF NEUROLOGY, KYPHOTIC ANGULATION AND PAIN

Muhammad Aamir, Zia Ur Rehman, Syed Shayan Shah, Muhammad Sohaib Khan, Adnan Khan, Syed Jawad Ahmad

Abstract

Background: Dorsolumbar fractures at the thoracolumbar junction (T11-L2) present therapeutic uncertainty when classified as Thoracolumbar Injury Classification and Severity Score (TLICS) 4. This prospective study evaluated the efficacy of conservative management in this injury category.

Materials & Methods: This prospective study was conducted in the department of Neurosurgery, Lady Reading Hospital, Peshawar from August 2024 to March 2025. Eighty-five patients (aged 18-45 years) with acute single-level dorsolumbar fractures (TLICS 4) were managed non-operatively using thoracolumbosacral orthosis (TLSO) immobilization for three weeks, followed by graded mobilization. Primary outcomes assessed at 12 weeks included neurological status (Medical Research Council scale), kyphotic angulation (Cobb angle >3° = significant change), and pain intensity (Visual Analog Scale; <4 = clinically significant improvement). Chi-square tests were applied using SPSS version 23.

Results: There was total 85 patients, comprising 61.2% males (n=52) and 38.8% females (n=33). Neurological recovery was observed in 67.1% of patients (n=57) achieving grade 5 muscle power, compared to 31.8% (n=27) at baseline. Pain reduction was substantial, with 62.4% (n=53) reporting mild pain versus 2.4% (n=2) initially. Kyphotic angulation remained stable in 56.5% (n=48), with only 2.4% (n=2) exhibiting progression exceeding 7°. Gender significantly influenced pain reduction (p=0.043) and neurological improvement (p=0.024), while trauma mechanism and injury level showed no significant associations.

Conclusions: Conservative management resulted in functional recovery in TLICS 4 fractures, with significant neurological improvement, pain reduction, and kyphotic stability. Gender-based outcome differences require further investigation. These findings support non-operative treatment as a primary strategy in appropriately selected patients.

Keywords

Back Injuries; Cohort Studies; Kyphosis; Neurologic Recovery; Orthotic Devices; Pain Measurement; Spinal Fractures; Thoracolumbar Spine.

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References

Mustafa B. The impact of spine pathology on posterior ligamentous complex structure and function. Curr Rev Musculoskelet Med. 2023;16(12):616-26. https://doi.org/10.1007/s12178-023-09834-6

Gnanenthiran SR, Adie S, Harris IA. Non-operative versus operative treatment for thoracolumbar burst fractures without neurologic deficit: a meta-analysis. Clin Orthop Relat Res. 2012;470(2):567-77. https://doi.org/10.1007/s11999-011-2157-7

Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):2028-37. https://doi.org/10.1097/BRS.0b013e3182a8a38

Khil EK, Choi I, Lee KY, Kim YW. Can conservative treatment be effective for thoracolumbar injuries patients with TLICS scores of 4 or 5? BMC Musculoskelet Disord. 2024;25(1):431. https://doi.org/10.1186/s12891-024-07324-6

Nau C, Pape HC, Jug M, Wendt K, Komadina R, Bloemers F. Thoracolumbar injuries: non-operative treatment: indications, management. Eur J Trauma Emerg Surg. 2024;50(5):1951-7. https://doi.org/10.1007/s00068-024-02619-3

Li T, Yan J, Liu X, Hu J, Wang F. Efficacy and safety of conservative treatment compared with surgical treatment for thoracolumbar fracture with score 4 TLICS. Clin Spine Surg. 2024;37(5):230-41. https://doi.org/10.1097/BSD.0000000000001503

Celebi L, Muratli HH, Dogan O, Yagmurlu MF, Aktekin CN, Tabak AY, et al. The efficacy of non-operative treatment of burst fractures of the thoracolumbar vertebra. Acta Orthop Traumatol Turc. 2015;49(1):84-91. https://doi.org/10.5152/aott.2015.14.319

Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-64. https://doi.org/10.1016/j.spinee.2012.10.041

Furlan JC, Noonan V, Cadotte DW, Fehlings MG. Timing of decompressive surgery of spinal cord after traumatic spinal cord injury. J Neurotrauma. 2011;28(8):1371-99. https://doi.org/10.1089/neu.2009.1147

Sadiqi S, Verlaan JJ, Lehr AM, Chapman JR, Dvorak MF, Kandziora F, et al. Measurement of kyphosis and vertebral body height loss in traumatic spine fractures. Eur Spine J. 2017;26(5):1483-91. https://doi.org/10.1007/s00586-016-4716-9

Goh TS, Shin JK, Youn MS, Lee HS, Kim TH, Lee JS. Surgical versus nonsurgical treatment of lumbar degenerative kyphosis. Eur Spine J. 2017;26(8):2153-9. https://doi.org/10.1007/s00586-017-5008-8

Guarnieri G, Izzo R, Muto M. The role of emergency radiology in spinal trauma. Br J Radiol. 2016;89(1061):20150833. https://doi.org/10.1259/bjr.20150833

Karaali E, Çiloğlu O, Duramaz A, Özkan AK, Ekiz T. Management of TLICS=4 thoracolumbar vertebra fractures: surgery versus conservative treatment. Ulus Travma Acil Cerrahi Derg. 2020;26(5):805-10. https://doi.org/10.14744/tjtes.2020.30524

Qadir I, Riew KD, Alam SR, Akram R, Waqas M, Aziz A. Timing of surgery in thoracolumbar spine injury: impact on neurological outcome. Glob Spine J. 2020;10(7):877-86. https://doi.org/10.1177/2192568219876258

Rampersaud YR, Power JD, Perruccio AV, Paterson JM, Veillette C, Coyte PC, et al. Healthcare utilization and costs for spinal conditions in Ontario. Spine J. 2020;20(6):874-81. https://doi.org/10.1016/j.spinee.2020.01.013

Rajasekaran S, Kanna RM, Schroeder GD, Oner FC, Vialle L, Chapman J, et al. Does the spine surgeon’s experience affect fracture classification and treatment plan? Glob Spine J. 2017;7(4):309-16. https://doi.org/10.1177/2192568217699209

Sidon E, Stein M, Ramalingam G, Shemesh S, Benharroch D, Ohana N. Gender differences in spinal injuries: causes and location. J Womens Health (Larchmt). 2018;27(7):946-51. https://doi.org/10.1089/jwh.2017.6687

Gill JS, Stippler M, Ruan Q, Hussain N, White AP, Oruhurhu V, et al. Validation of TLICS in osteoporotic vertebral compression fractures. Interv Pain Med. 2024;3(3):100438. https://doi.org/10.1016/j.inpm.2024.100438

Kim DH, Vaccaro AR, Chapman JR, et al. Indications for nonsurgical treatment of thoracolumbar spine fractures: WFNS Spine Committee recommendations. Neurospine. 2021;18(4):704-12. https://doi.org/10.14245/ns.2142346.173

Wendt K, Nau C, Jug M, Pape HC, Kdolsky R, Thomas S, et al. ESTES recommendation on thoracolumbar spine fractures. Eur J Trauma Emerg Surg. 2024;50(4):1261-75. https://doi.org/10.1007/s00068-024-02584-x

Loughenbury PR, Tsirikos AI. Indications and principles of conservative treatment in vertebral injuries. Orthop Trauma. 2020;34(5):291-7. https://doi.org/10.1016/j.mporth.2020.07.004

Zhou Y, Wang Y, Zhang H, Sun Z, Li C. The neurologically intact patient with TLICS 4 or 5 burst fractures: is conservative management safe? Medicine (Baltimore). 2024;103(45):e38316. https://doi.org/10.1097/MD.0000000000038316

DOI: https://doi.org/10.46903/gjms/23.4.2089