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Glendale, CA 91206
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Recent Advances in the Treatment of Spinal Burst Fractures

Posted on: 06/27/2012
Until recently, if you or a loved one had a burst fracture of the spine, your treatment would be determined by the surgeon based on his or her knowledge and experience rather than on evidence of what works best. All that has changed now with a new tool called the Thoracolumbar Injury Classification and Severity (TLICS) System.

The TLICS guides the surgeon in making the best decision for each individual patient. It takes into consideration 1) the type of fracture you have and 2) any neurologic problems present as a result of the fracture. The TLICS also takes into account 3) whether or not the ligaments supporting the spine are damaged leaving the spine unstable.

A burst fracture is just as the name suggests. There isn't a single, simple fracture but many fracture lines throughout the vertebral body (spinal bone). Pressure and load on the fractured bone can cause the vertebra to collapse.

Not all burst fractures require surgical treatment. Some can be treated with conservative (nonoperative) care. The question is: who needs surgery and who doesn't? Are there ways to predict the most optimal treatment?

Yes, now with this new reliable instrument, a severity score can be determined and used to guide the treatment decision. As the name indicates, fractures of the vertebrae at the junction between the thoracic and lumbar spines are the target for this treatment strategy.

The score given to each patient assigns a value from zero to three for each of the three categories mentioned. A total score of three or less suggests conservative care without surgery is possible. Patients with a score of five will need surgery. Anyone with a four falls in a gray zone that requires careful consideration of all the individual patient factors. Surgeon experience, judgment, and expertise are required for these "inbetween" cases.

The additional value of a tool like the TLICS is research. Studying optimal surgical methods is now possible. Surgeons can use this tool to track results and compare them when using one of several different surgical techniques. The most common surgical approach is a spinal fusion.

The fusion may (or may not) require the use of hardware such as metal plates, rods, screws or wires. Use of these devices is called instrumentation or fixation. A score of five or more tells the surgeon that the spine is unstable and fusion is needed. But exactly which approach to use (anterior, posterior, or a combination of both) will still require further study.

The TLICS system will eventually reveal which fusion technique and type of fixation will provide patients with a stable correction that lasts. After surgery, loss of spinal alignment and the development of spinal deformities can be evaluated and given a number based on severity. Likewise, neurologic status and spinal stability can be rated and classified.

In summary, the TLICS system is a reliable and evidence-based tool for directing treatment of thoracolumbar burst fractures. It doubles as a guiding tool for who needs surgery and will eventually reveal which surgery is advised for each patient.

The added value of such a system is in tracking the results of minimally invasive surgeries. And minimally invasive can mean less time in surgery, low blood loss, faster return-to-home, and fewer neurologic complications.

References:
James W. Woodahl, Jr, MD, PhD, and Robert A. McGuire. Evidence for the Treatment of Thoracolumbar Burst Fractures. In Current Orthopaedic Practice. May/June 2012. Vol. 23. No. 3. Pp. 188-192.

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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.


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