To investigate the application of combination of thoracolumbar injury classification severity score and load sharing classification (TLICS+ LSC) in deciding the surgery for thoracolumbar fractures.

A retrospective case series study was conducted to analyze the clinical data of 42 patients with thoracolumbar fractures admitted to Sir RunRun Shaw Hospital affiliated to Medical College of Zhejiang University from January 2013 to November 2015. There were 28 males and 14 females, aged 19-58 years [(39.5±11.5)years]. The injured segments included T₁₁ in 2 patients, T₁₂ in 12, L₁ in 4, L₂ in 24. According to American Spinal Injury Association (ASIA) classification, there were two patients with grade A, five patients with grade B, six patients with grade C, and two patients with grade D. The rest of the patients had good neurological function. Surgical methods were selected according to the TLICS+ LSC system. Seventeen patients were treated with posterior internal fixation (TLICS>4 points, LSC<7 points) (Group A), 19 patients were treated with anterior reconstruction and internal fixation (TLICS≤4 points, LSC≥7 points) (Group B), and six patients were treated with anterior reconstruction and posterior internal fixation (TLICS>4 points, LSC≥7 points) (Group C). ASIA grading criteria were used to assess the neurological function recovery of the patients. Vertebral height and sagittal Cobb angle changes were measured on full-length, lateral X-ray or CT sagittal reconstruction images. Artificial vertebral body and screw loosening were observed on lateral X-ray or CT sagittal reconstruction images. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were used to evaluate pain relief and functional recovery.

All patients were followed up for 18-24 months [(22.2±2.0)months]. base on ASIA grading criteria: one grade A (Group C) was restored to grade C, three grade B (Group B) were restored to grade D, two grade B (Group C) were restored to grade C, six grade C (four in Group A, two in Group B) and two grade D (Group A) were restored to grade E (P<0.05). The correction of sagittal Cobb angle was restored from (26.1±5.6)° before surgery to (3.7±1.5)° immediately after surgery and was (4.8±1.0)° at last follow-up (P<0.05). There was no loosening of artificial vertebral body or screw in any patient. The VAS score dropped from (6.3±0.9)points before surgery to (2.0±0.7)points at the last follow-up, and ODI score was also significantly decreased from (72.6±9.2)points before surgery to (25.2±5.2)points at the last follow-up (P<0.05).

The combination of TLICS and LSC can clearly guide the surgical decision-making of patients with thoracolumbar fracture. The operation plan can be made according to the results of the combined scoring. After the operation, the local kyphosis angle of the patients recovers significantly, the pain is relieved and the function is improved significantly.

Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Program evaluation