• Journal of Korean Neurosurgical Society
• /
• v.57 no.3
• /
• pp.174-177
• /
• 2015

Objective : For improving the drawbacks of previous thoracolumbar spine trauma classification, the Spine Trauma Study Group was developed new classification, Thoracolumbar Injury Classification and Severity Score (TLICS). The simplicity of this scoring system makes it useful clinical application. However, considering criteria of Korean Health Insurance Review and Assessment Service (HIRA), the usefulness of TLICS system is still controversial in the treatment decision of thoracolumbar spine injury. Methods : Total 100 patients, who admitted to our hospital due to acute traumatic thoracolumbar injury, were enrolled. In 45, surgical treatment was performed and surgical treatment was decided following the criteria of HIRA in all patients. With assessing of TLICS score and Denis's classification, the treatment guidelines of TLICS and Denis's classification were applied to the criteria of Korean HIRA. Results : According to the Denis's three-column spine system, numbers of patients with 2 or 3 column injuries were 94. Only 45 of 94 patients (47.9%) with middle column injury fulfilled the criteria of HIRA. According to TLICS system, operation required fractures (score>4) were 31 and all patients except one fulfilled the criteria of HIRA. Conservative treatment required fractures (score<4) were 52 and borderline fracture (score=4) were 17. Conclusion : The TLICS system is very useful system for decision of surgical indication in acute traumatic thoracolumbar injury. However, the decision of treatment in TLICS score 4 should be carefully considered. Furthermore, definite criteria of posterior ligamentous complex (PLC) injury may be necessary because the differentiation of PLC injury between TLICS score 2 and 3 is very difficult.

• Journal of Trauma and Injury
• /
• v.31 no.2
• /
• pp.76-81
• /
• 2018

Fractures at the thoracolumbar region are commonly followed after major traumatic injuries, and up to 20% of these fractures are known to be burst fractures. Making surgical decisions for these patients are of great interest however there is no golden standard so far. Since the introduction of Thoracolumbar Injury Classification and Severity (TLICS) score in 2007, it has been widely used as a referential guideline for making surgical decisions in thoracolumbar fractures. However, there is still limitations in this system. In this clinical case report, we introduce a L1 burst fracture after motor vehicle injury, who was successfully treated conservatively even while she was graded as a TLICS 5 injury. A case report is presented as well as discussion on the limitations of this grading system.

• Journal of Korean Neurosurgical Society
• /
• v.63 no.6
• /
• pp.794-805
• /
• 2020

Objective : Teriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture. Methods : This retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61-88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC). Results : There were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05). Conclusion : Non-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.

• Journal of Korean Medicine Rehabilitation
• /
• v.33 no.4
• /
• pp.109-124
• /
• 2023

Objectives This study aims to find out effect of Korean medicine treatment on managing thoracolumbar compression fractures through retrospective observational study. Methods Among hospitalized patients at the Department of Korean Medicine Rehabilitation from January 1st, 2018 to February 28th, 2023, a total of 24 inpatients who were diagnosed with thoracolumbar compression fractures and received Korean medicine treatment were included in this study. Numeric rating scale (NRS) was used for pain assessment and clinical variables such as sex, symptoms, age, thoracolumbar injury classification and severity (TLICS) scores were collected. For subgroup analysis to analyze factors affecting treatment response, we divided patients into responders and non-responders according to NRS change. For statistical analysis, we compared before/after hospitalization and analyzed distinct features between two groups. Results Most of the patients were in their 70s and 83.33% were female. Average hospitalization period was 24.54±11.91 days. All patients had back pain as their chief complaint and only 2 patients received surgeries. In TLICS, only 1 patient got score 6, which represented surgery indication. After Korean medicine treatment, NRS of almost every patient got lower significantly at the time of discharge (3.02±1.93) than admission (5.52±1.95). Comparing two groups, responders had lower NRS at the time of discharge and TLICS score of them were lower than non-responders. Conclusions Our results show that Korean medicine treatment for thoracolumbar compression fractures was effective in reducing pain. There were distinct clinical features such as age, past history, surgeries between those with significant improvement in pain scores and those who did not.