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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Basu S (2012) Spinal injuries in children. Front Neurol. https://doi.org/10.3389/fneur.2012.00096
Parent S, Mac-Thiong J-M, Roy-Beaudry M et al (2011) Spinal cord injury in the pediatric population: a systematic review of the literature. J Neurotrauma 28:1515–1524. https://doi.org/10.1089/neu.2009.1153
Mo AZ, Miller PE, Troy MJ et al (2019) The AOSpine thoracolumbar spine injury classification system: A comparative study with the thoracolumbar injury classification system and severity score in children. The Open Access Journal of Orthopaedic Trauma OTA International 2:e036. https://doi.org/10.1097/OI9.0000000000000036
Saul D, Dresing K (2018) Epidemiology of vertebral fractures in pediatric and adolescent patients. Pediatr Rep. https://doi.org/10.4081/pr.2018.7232
Magerl F, Aebi M, Gertzbein SD et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201
Kepler CK, Vaccaro AR, Schroeder GD et al (2016) The thoracolumbar AOSpine injury score. Global Spine J 6:329–334. https://doi.org/10.1055/s-0035-1563610
Vaccaro AR, Schroeder GD, Kepler CK et al (2016) The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J 25:1087–1094. https://doi.org/10.1007/s00586-015-3982-2
Vaccaro AR, Oner C, Kepler CK et al (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 38:2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381
Dawkins RL, Miller JH, Menacho ST et al (2018) Thoracolumbar injury classification and severity score in children: a validity study. Neurosurgery. https://doi.org/10.1093/neuros/nyy408
Kaul R, Chhabra HS, Vaccaro AR et al (2017) Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study. Eur Spine J 26:1470–1476. https://doi.org/10.1007/s00586-016-4663-5
Dawkins RL, Miller JH, Ramadan OI et al (2018) Thoracolumbar injury classification and severity score in children: a reliability study. J Neurosurg Pediatr 21:284–291. https://doi.org/10.3171/2017.7.PEDS1720
Vaccaro AR, Lehman RA, Hurlbert RJ et al (2005) A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 30:2325–2333. https://doi.org/10.1097/01.brs.0000182986.43345.cb
Dauleac C, Beuriat P-A, Di Rocco F et al (2019) Surgical management of pediatric spine trauma: 12 years of experience. World Neurosurg 126:e1494–e1502. https://doi.org/10.1016/j.wneu.2019.03.134
Abedi A, Mokkink LB, Zadegan SA et al (2019) Reliability and validity of the AOSpine thoracolumbar injury classification system: a systematic review. Global Spine J 9:231–242. https://doi.org/10.1177/2192568218806847
Joaquim AF, de Almeida Bastos DC, Jorge Torres HH, Patel AA (2016) Thoracolumbar injury classification and injury severity score system: a literature review of its safety. Global Spine J 6:80–85. https://doi.org/10.1055/s-0035-1554775
Sellin JN, Steele WJ, Simpson L et al (2016) Multicenter retrospective evaluation of the validity of the Thoracolumbar Injury Classification and Severity Score system in children. J Neurosurg Pediatr 18:164–170. https://doi.org/10.3171/2016.1.PEDS15663
Onen MR, Naderi S (2015) Pediatric spine trauma. J Spine. https://doi.org/10.4172/2165-7939.1000211
Joaquim AF, Daubs MD, Lawrence BD et al (2013) Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients. Spine J 13:1760–1765. https://doi.org/10.1016/j.spinee.2013.03.014
Pang D, Wilberger JE (1982) Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57:114–129. https://doi.org/10.3171/jns.1982.57.1.0114
Brauge D, Plas B, Vinchon M et al (2020) Multicenter study of 37 pediatric patients with SCIWORA or other spinal cord injury without associated bone lesion. Orthop Traumatol Surg Res 106:167–171. https://doi.org/10.1016/j.otsr.2019.10.006
Srinivasan V, Jea A (2017) Pediatric thoracolumbar spine trauma. Neurosurg Clin N Am 28:103–114. https://doi.org/10.1016/j.nec.2016.07.003
Slotkin JR, Lu Y, Wood KB (2007) Thoracolumbar spinal trauma in children. Neurosurg Clin N Am 18:621–630. https://doi.org/10.1016/j.nec.2007.07.003
Daniels AH, Sobel AD, Eberson CP (2013) Pediatric thoracolumbar spine trauma. J Am Acad Orthop Surg 21:707–716. https://doi.org/10.5435/JAAOS-21-12-707
Piazzolla A, Solarino G, Moretti B (2017) Letter to the Editor concerning “The surgical algorithm for the AOSpine thoracolumbar spine injury classification system” by A. R. Vaccaro et al. Eur Spine J (2016);25(4):1087–1094. Eur Spine J 26:2214–2215. https://doi.org/10.1007/s00586-017-5174-8
McCormack T, Karaikovic E, Gaines RW (1994) The load sharing classification of spine fractures. Spine 19:1741–1744. https://doi.org/10.1097/00007632-199408000-00014
No source of financial and material support.
Conflict of interest
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Dauleac, C., Mottolese, C., Beuriat, PA. et al. Superiority of thoracolumbar injury classification and severity score (TLICS) over AOSpine thoracolumbar spine injury classification for the surgical management decision of traumatic spine injury in the pediatric population. Eur Spine J (2021). https://doi.org/10.1007/s00586-020-06681-4
- Spine injury
- Spine growth