Measuring the impact of the Thoracolumbar Injury Classification and Severity Score among 458 consecutively treated patients

Context: The Thoracolumbar Injury Classification and Severity Score (TLICS) was proposed to improve injury classification and guide surgical decision-making of thoracolumbar spinal trauma (TLST), but its impact on the care of patients has not been quantified. Study design: Retrospective study. Patient sample: Analysis of 458 patients treated for TLST trauma from 2000 through 2010 at a single center. Outcome measures: Neurological status - ASIA Impairment Scale (AIS), failure of conservative treatment, and surgical complications. Methods: Clinical and radiological data were evaluated. Patients were grouped according to the period before (2000-2006) and after (2007-2010) utilization of the TLICS. Results: From 2000 to 2006, 148 patients were initially treated conservatively (C) and 66 were surgically (S) treated. In the C group, the TLICS ranged from 1 to 7 (median 1; mean 1.57). In the S group, the TLICS ranged from 2 to 10 (median 2; mean 4.14). The TLICS matched treatment in 97.9% of conservatively treated patients. From 2007 to 2010, 162 patients were initially treated C and 82 were treated S. In the C group, the TLICS ranged from 1 to 4 (median 1; mean 1.48). In the S group, the TLICS ranged from 2-10 (median 4; mean 4.4). The TLICS matched treatment in 98.8% of C-treated patients. Overall, failure of C treatment occurred in nine patients; most failures (7/9) and all three missed distractive injuries occurred prior to use of the TLICS. Conclusions: After introduction of the TLICS, there was a trend towards more successful conservative treatment with fewer conversions to surgical treatment.