Corentin Dauleac1,2, Carmine Mottolese1,3, Pierre-Aurélien Beuriat1,2,3, Alexandru Szathmari1,3, Federico Di Rocco4,5. 1. Service de Neurochirurgie, Hospices Civils de Lyon, Hôpital Neurologique Et Neurochirurgical Pierre Wertheimer, 69003, Lyon, France. 2. Université de Lyon, Université Claude Bernard, 69008, Lyon, France. 3. Service de Neurochirurgie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bd Pinel, 69003, Lyon, France. 4. Université de Lyon, Université Claude Bernard, 69008, Lyon, France. federico.dirocco@chu-lyon.fr. 5. Service de Neurochirurgie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bd Pinel, 69003, Lyon, France. federico.dirocco@chu-lyon.fr.
Abstract
PURPOSE: Thoracolumbar fractures are the most common kind of spine injury in children. Several types of spine injury can occur, and for this reason, treatment algorithms have been put in place for the management of these patients. At present, the thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AOSpine injury score (AOSpine score) aimed at providing treatment recommendations. We aimed to assess the reliability, in children, of the TLICS scoring and AOSpine scoring systems, and to define the superiority of one of the methods of scoring, to spread its use in routine clinical management in the pediatric spine trauma. METHODS: A retrospective chart review of consecutive children admitted to a Level 1 trauma center for traumatic thoracolumbar fractures, between 2006 and 2019, was performed. We compared the management we performed in clinical practice in children with spine trauma, to the decisional algorithms based on the TLICS and AOSpine scores. According to these scores, surgical treatment should be performed when the TLICS score ≥ 5 and the AOSpine score > 5; and surgical or conservative treatment was considered reasonable when the TLICS score = 4 and the AOSpine score = 4 or 5. Surgical indications were based on the clinical status, the anatomy of the fracture, and the risk of sagittal imbalance of the growing spine. RESULTS: Fifty-four patients met the inclusion criteria. We demonstrated that both the AOSpine score and the TLICS scores had a significant correlation for surgical management decision of spine trauma (p < 0.0001). We found a high concordance between surgical decision making in the pediatric clinical practice and the TLICS score. In our pediatric cohort, there were significantly more patients with TLICS ≥ 5 (n = 47, 87%) than with AOSpine score > 5 (n = 26, 46%, p < 0.0001). There were significantly more patients with TLICS ≥ 4 (n = 53, 98%), than with AOSpine score ≥ 4 (n = 42, 77%, p = 0.001). ConclusionsThe TLICS score was significantly more appropriate than the AOSpine score, for the surgical treatment decision in children, especially when considering the future risk of sagittal imbalance.
PURPOSE: Thoracolumbar fractures are the most common kind of spine injury in children. Several types of spine injury can occur, and for this reason, treatment algorithms have been put in place for the management of these patients. At present, the thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AOSpine injury score (AOSpine score) aimed at providing treatment recommendations. We aimed to assess the reliability, in children, of the TLICS scoring and AOSpine scoring systems, and to define the superiority of one of the methods of scoring, to spread its use in routine clinical management in the pediatric spine trauma. METHODS: A retrospective chart review of consecutive children admitted to a Level 1 trauma center for traumatic thoracolumbar fractures, between 2006 and 2019, was performed. We compared the management we performed in clinical practice in children with spine trauma, to the decisional algorithms based on the TLICS and AOSpine scores. According to these scores, surgical treatment should be performed when the TLICS score ≥ 5 and the AOSpine score > 5; and surgical or conservative treatment was considered reasonable when the TLICS score = 4 and the AOSpine score = 4 or 5. Surgical indications were based on the clinical status, the anatomy of the fracture, and the risk of sagittal imbalance of the growing spine. RESULTS: Fifty-four patients met the inclusion criteria. We demonstrated that both the AOSpine score and the TLICS scores had a significant correlation for surgical management decision of spine trauma (p < 0.0001). We found a high concordance between surgical decision making in the pediatric clinical practice and the TLICS score. In our pediatric cohort, there were significantly more patients with TLICS ≥ 5 (n = 47, 87%) than with AOSpine score > 5 (n = 26, 46%, p < 0.0001). There were significantly more patients with TLICS ≥ 4 (n = 53, 98%), than with AOSpine score ≥ 4 (n = 42, 77%, p = 0.001). ConclusionsThe TLICS score was significantly more appropriate than the AOSpine score, for the surgical treatment decision in children, especially when considering the future risk of sagittal imbalance.
Authors: Ross L Dawkins; Joseph H Miller; Omar I Ramadan; Michael C Lysek; Elizabeth N Kuhn; Brandon G Rocque; Michael J Conklin; R Shane Tubbs; Beverly C Walters; Bonita S Agee; Curtis J Rozzelle Journal: J Neurosurg Pediatr Date: 2018-01-12 Impact factor: 2.375
Authors: Alexander R Vaccaro; Ronald A Lehman; R John Hurlbert; Paul A Anderson; Mitchel Harris; Rune Hedlund; James Harrop; Marcel Dvorak; Kirkham Wood; Michael G Fehlings; Charles Fisher; Steven C Zeiller; D Greg Anderson; Christopher M Bono; Gordon H Stock; Andrew K Brown; Timothy Kuklo; F C Oner Journal: Spine (Phila Pa 1976) Date: 2005-10-15 Impact factor: 3.468
Authors: Alexander R Vaccaro; Gregory D Schroeder; Christopher K Kepler; F Cumhur Oner; Luiz R Vialle; Frank Kandziora; John D Koerner; Mark F Kurd; Max Reinhold; Klaus J Schnake; Jens Chapman; Bizhan Aarabi; Michael G Fehlings; Marcel F Dvorak Journal: Eur Spine J Date: 2015-05-08 Impact factor: 3.134
Authors: Alexander R Vaccaro; Cumhur Oner; Christopher K Kepler; Marcel Dvorak; Klaus Schnake; Carlo Bellabarba; Max Reinhold; Bizhan Aarabi; Frank Kandziora; Jens Chapman; Rajasekaran Shanmuganathan; Michael Fehlings; Luiz Vialle Journal: Spine (Phila Pa 1976) Date: 2013-11-01 Impact factor: 3.468
Authors: Christopher K Kepler; Alexander R Vaccaro; Gregory D Schroeder; John D Koerner; Luiz R Vialle; Bizhan Aarabi; Shanmuganathan Rajasekaran; Carlo Bellabarba; Jens R Chapman; Frank Kandziora; Klaus J Schnake; Marcel F Dvorak; Max Reinhold; F Cumhur Oner Journal: Global Spine J Date: 2015-09-29
Authors: Ajay X Thomas; James J Riviello; Daniel Davila-Williams; Sruthi P Thomas; Jennifer C Erklauer; David F Bauer; Jon A Cokley Journal: Curr Treat Options Neurol Date: 2022-06-10 Impact factor: 3.972