Abstract
Background
The classification and therapeutic strategy for thoracolumbar burst fractures are controversial. The load-sharing classification (LSC) and thoracolumbar injury classification system (TLICS) are both quantitative evaluation systems for thoracolumbar burst fractures. We hypothesized that their combination would be helpful not only for surgical indications but also for deciding on the surgical approach. However, no reports have evaluated the relationship between them. The purpose of this study was to clarify the relationship between the LSC and TLICS and investigate the clinical usefulness of their combination.
Methods
This study included 100 consecutive patients surgically treated for thoracolumbar burst fractures (71 men and 29 women; mean age 36 years). Clinical and radiographical data as well as thoracolumbar injury classification systems were evaluated.
Results
LSC and TLICS scores were found to be statistically correlated. The mean LSC score with a TLICS score of 5 or more (surgical treatment recommended) was 7.3 ± 1.2 points, and the mean LSC score with a TLICS score of 3 or less (conservative treatment recommended) was 6.1 ± 1.3 points. The mean TLICS score with an LSC score of 7 or more (additional anterior reconstruction recommended) was 6.6 ± 2.7 points, and the mean TLICS score with an LSC score of 6 or less (expectation of good clinical results with posterior short fusion) was 5.0 ± 2.5 points. The TLICS score was 3 or less, and the LSC score was 7 or more in 13 patients (13 %).
Conclusion
Although the TLICS scores correlated with the LSC scores, a single application of TLICS might not be sufficient to identify those patients who have a TLICS score of 3 or less and an LSC score of 7 or more as surgically indicated. However, an additional LSC evaluation avoided deviations as the two classifications complemented each other, and it was useful in determining the best treatment options for thoracolumbar burst fractures.
Similar content being viewed by others
References
Vaccaro AR, Kim DH, Brodke DS, Harris M, Chapman JR, Schildhauer T, Routt ML, Sasso RC. Diagnosis and management of thoracolumbar spine fractures. Instr Course Lect. 2004;53:359–73.
Verlaan JJ, Diekerhof CH, Buskens E, van der Tweel I, Verbout AJ, Dhert WJ, Oner FC. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine. 2004;29:803–14.
van der Roer N, de Lange ES, Bakker FC, de Vet HC, van Tulder MW. Management of traumatic thoracolumbar fractures: a systematic review of the literature. Eur Spine J. 2005;14:527–34.
Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, Rommens PM, ten Duis HJ, Patka P. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine. 2006;31:2881–90.
Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;8:817–31.
Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3:184–201.
McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine. 1994;19:1741–4.
Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine. 2005;30:2325–33.
Dai LY, Jin WJ. Interobserver and intraobserver reliability in the load sharing classification of the assessment of thoracolumbar burst fractures. Spine. 2005;30:354–8.
Wang XY, Dai LY, Xu HZ, Chi YL. The load-sharing classification of thoracolumbar fractures: an in vitro biomechanical validation. Spine. 2007;32:1214–9.
Joaquim AF, Fernandes YB, Cavalcante RA, Fragoso RM, Honorato DC, Patel AA. Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma. Spine. 2011;36:33–6.
Oner FC, Wood KB, Smith JS, Shaffrey CI. Therapeutic decision making in thoracolumbar spine trauma. Spine. 2010;35:S235–44.
Vaccaro AR, Rihn JA, Saravanja D, Anderson DG, Hilibrand AS, Albert TJ. Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine. 2009;34:E841–7.
Yukawa Y. Anterior and posterior surgery and fixation for burst fractures. In: Patel VV, Burger E, Brown CW, editors. Spine trauma, surgical techniques. 1st ed. Berlin: Springer; 2010. p. 299–309.
Machino M, Yukawa Y, Ito K, Nakashima H, Kato F. Posterior/anterior combined surgery for thoracolumbar burst fractures—posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting. Spinal Cord. 2011;49:573–9.
White AA III, Panjabi MM. Update on the evaluation of instability of the lower cervical spine. Instr Course Lect. 1987;36:513–20.
White AA III, Panjabi MM. Clinical biomechanics of the spine. 2nd ed. Philadelphia: JB Lippincott; 1990.
Vaccaro AR, Baron EM, Sanfilippo J, Jacoby S, Steuve J, Grossman E, DiPaola M, Ranier P, Austin L, Ropiak R, Ciminello M, Okafor C, Eichenbaum M, Rapuri V, Smith E, Orozco F, Ugolini P, Fletcher M, Minnich J, Goldberg G, Wilsey J, Lee JY, Lim MR, Burns A, Marino R, DiPaola C, Zeiller L, Zeiler SC, Harrop J, Anderson DG, Albert TJ, Hilibrand AS. Reliability of a novel classification system for thoracolumbar injuries: the thoracolumbar injury severity score. Spine. 2006;31:S62–9.
Harrop JS, Vaccaro AR, Hurlbert RJ, Wilsey JT, Baron EM, Shaffrey CI, Fisher CG, Dvorak MF, Oner FC, Wood KB, Anand N, Anderson DG, Lim MR, Lee JY, Bono CM, Arnold PM, Rampersaud YR, Spine Trauma Study Group. Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. J Neurosurg Spine. 2006;4:118–22.
Patel AA, Vaccaro AR, Albert TJ, Hilibrand AS, Harrop JS, Anderson DG, Sharan A, Whang PG, Poelstra KA, Arnold P, Dimar J, Madrazo I, Hegde S. The adoption of a new classification system: time-dependent variation in interobserver reliability of the thoracolumbar injury severity score classification system. Spine. 2007;32:E105–10.
Raja Rampersaud Y, Fisher C, Wilsey J, Arnold P, Anand N, Bono CM, Dailey AT, Dvorak M, Fehlings MG, Harrop JS, Oner FC, Vaccaro AR. Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study. J Spinal Disord Tech. 2006;19:477–82.
Acknowledgments
No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.
Conflict of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Machino, M., Yukawa, Y., Ito, K. et al. The complement of the load-sharing classification for the thoracolumbar injury classification system in managing thoracolumbar burst fractures. J Orthop Sci 18, 81–86 (2013). https://doi.org/10.1007/s00776-012-0319-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00776-012-0319-4