Risk Factors for the Failure of Spinal Burst Fractures Treated Conservatively According to the Thoracolumbar Injury Classification and Severity Score TLICS: A Retrospective Cohort TrialReportar como inadecuado




Risk Factors for the Failure of Spinal Burst Fractures Treated Conservatively According to the Thoracolumbar Injury Classification and Severity Score TLICS: A Retrospective Cohort Trial - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

The management of thoracolumbar TL burst fractures is still controversial. The thoracolumbar injury classification and severity score TLICS algorithm is now widely used to guide clinical decision making, however, in clinical practice, we come to realize that TLICS also has its limitations for treating patients with total scores less than 4, for which conservative treatment may not be optimal in all cases.

Purpose

The aim of this study is to identify several risk factors for the failure of conservative treatment of TL burst fractures according to TLICS algorithm.

Methods

From June 2008 to December 2013, a cohort of 129 patients with T10-l2 TL burst fractures with a TLISC score ≤3 treated non-operatively were identified and included into this retrospective study. Age, sex, pain intensity, interpedicular distance IPD, canal compromise, loss of vertebral body height and kyphotic angle KA were selected as potential risk factors and compared between the non-operative success group and the non-operative failure group.

Results

One hundred and four patients successfully completed non-operative treatment, the other 25 patients were converted to surgical treatment because of persistent local back pain or progressive neurological deficits during follow-up. Our results showed that age, visual analogue scale VAS score and IPD, KA were significantly different between the two groups. Furthermore, regression analysis indicated that VAS score and IPD could be considered as significant predictors for the failure of conservative treatment.

Conclusion

The recommendation of non-operative treatment for TLICS score ≤3 has limitations in some patients, and VAS score and IPD could be considered as risk factors for the failure of conservative treatment. Thus, conservative treatment should be decided with caution in patients with greater VAS scores or IPD. If non-operative management is decided, a close follow-up is necessary.



Autor: Jieliang Shen, Linfei Xu, Baolong Zhang , Zhenming Hu

Fuente: http://plos.srce.hr/



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