Clinical Analysis Of Thoracolumbar Injury Classification

Background and objective: Thoracolumbar injury and fracture is the most common spinal injury. Thoracolumbar injury is the injury from T11 to L2 segment. It is about 62.4% of the whole thoracic and lumbar spine injury .Injury of T12 and L1 is about 44.8%.The high incidence of thoracolumbar injury have much to do with the anatomy of thoracolumbar . The activity of thoracic spine is relatively small, while the relatively large degree of lumbar. Thoracolumbar segment is the junction of both sides. It is the transition point of activity level of the spine area. Such fractures occurred mostly in young adults, high-energy injury is a major causative factor. But the treatment of thoracolumbar fractures has long been a big controversy. The reason was mainly due to the current classification of thoracolumbar spine injury and scoring system evaluation is uneven, and can not be a good guide towards thoracolumbar injury diagnosis and treatment. At present AO and Denis classification system is the most commonly used classification system for thoracolumbar spine. In 2005 ,the U.S. team has developed a set of spinal injuries of thoracolumbar scoring system, and called the thoracolumbar injury classification and scoring system (Thoracolumbar Injury Classification and Severity Score, TLICS). At present the main arguments of the treatment of thoracolumbar fractures are: (1) surgical or non-surgical treatment; (2) treatment of anterior or posterior or combined approach to treat; (3) long-segment or short segment fixation. This study is intended that using Denis, AO, and TLICS classification systems for pathological retrospective study .Try to find relationship of fracture classification and treatment. We also look forward to investigate the problems of treating thoracolumbar fracture discussed above and provide the basis for the formulation and implementation for clinical treatment programs.Method: Collect 301 cases of thoracolumbar fracture patients treated in China-Japan Union Hospital Jilin University from March 2007 to November 2009.we try to gather the imaging data of 301 cases of patients. we obtain 141 cases. We investigate the method of treatment and follow-up effect of the treatment through telephone and outpatient service. Finally,a complete follow-up of 94 cases were finished.of Access to relevant medical information about preoperative symptoms, including pain, spinal function and neurological symptoms. use lumbar JOA score and record the results. Phone, out-patient follow-up is carried out to record recovering condition after treatment, including pain, spinal flexion and extension motor function neurological symptoms and using lumbar JOA score and recorded them . we conducted a retrospective study of cases, intending to analysis and evaluate the effect of the treatment methods in different thoracolumbar fracture classification system through the statistical study.Result: morphological analyzing of 94 cases, there is no significant difference between surgical treatment and non-surgical treatment (P> 0.05) in compression fracture of Denis classification and the A1.1 and A1.2 fractures of the AO classification.There is statistical significant difference between the non-surgical treatment and surgical treatment (P <0.05) in Burst fractures of Denis classification and A3.1 type fracture of AO classification. While treating with long segment and short-segment ,there are also significant difference (P <0.05).Flexion-distraction and dislocation injury of Denis classification and B, C-type injuries of AO classification of of at least two columns combined injury,there is statistical significant difference (P <0.05)between non-surgical treatment and surgical treatment, and Long-segment fixation should be recommended.The patients whose TLICS score less than 3, there is no significant difference (P> 0.05)between the surgical treatment and non-surgical treatment. The result is the same as standards given by the Spine Trauma Study Group.The patients whose TLICS score more than 5, there is significant difference (P> 0.05)between the surgical treatment and non-surgical treatment. The result is the same as standards given by the Spine Trauma Study Group.There are 13 cases patients whose TLICS score are 4 points, non-surgical treatment of 5 cases, surgical treatment of 8 cases . The followed up improvement rate of non-surgical is (41.8±7.4)%,the improvement rate of surgical treatment is (72.4±6.7)%. There is Statistical significant difference between the two proups (P <0.05). The follow up improvement rate of non-surgical group is 40%, 30.8%, 38.5%, 50%, 46.2%, improvement rate is between 25 ~ 60% .The effectiveness is moderate. There are two of which appear in pain, three cases of limitation of spinal activities which combined with difficulties od anterocollis in daily life . The patients whose TLICS scores are 4 points , most of them without neurological symptoms.The majority fracture type are burst fracture in Denis classification and A3.1 in AO classification.It is to be noted they may combine with the PLC injury. We can reconstruction spinal stability and repair posterior ligament through surgical treatment. Therefore ,we also can reduce the long-term complications and improve quality of life.Through case analysis, we establish a new classification system of thoracolumbar fractures based on Ferguson's three-column concept.Conclusion: We establish a new classification system of thoracolumbar fractures . The general principles for treatment is: Type A and B injury are stable, which should recept conservative treatment; Type C injury surgical treatment is superior to non-surgical treatment. short-segment posterior pedicle screw fixation is recommended. Type D, E injury should be used long-segment posterior pedicle screw fixation.