Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5128-5138
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5128
Assessment of load-sharing thoracolumbar injury: A modified scoring system
Qi-Hang Su, Yong-Chao Li, Yan Zhang, Jun Tan, Biao Cheng
Qi-Hang Su, Biao Cheng, Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
Qi-Hang Su, Yong-Chao Li, Yan Zhang, Jun Tan, Department of Orthopedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
Author contributions: Su QH and Li YC contributed equally to this work; Su QH and Cheng B designed research; Su QH, Zhang Y, Li YC, and Tan J performed the research; Su QH and Li YC contributed new analytic tools; Su QH, Li YC, and Cheng B analyzed data; Su QH wrote the paper.
Supported by Multicenter Clinical Trial of hUC-MSCs in the Treatment of Late Chronic Spinal Cord Injury, No. 2017YFA0105404; and the Project of Shanghai Science and Technology Commission, No. 19441901702.
Institutional review board statement: Shanghai East Hospital (East Hospital Affiliated to Tongji University) Medical Ethics Committee approved the study protocol, which met the relevant guidelines and regulations of Shanghai Medical Ethics Committee.
Informed consent statement: All included volunteers had signed an informed consent form.
Conflict-of-interest statement: The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [15221378017@163.com]. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Biao Cheng, MD, PhD, Doctor, Professor, Surgeon Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Shanghai 200072, China. dr_chengbiao@163.com
Received: May 12, 2020
Peer-review started: May 12, 2020
First decision: September 14, 2020
Revised: September 14, 2020
Accepted: September 23, 2020
Article in press: September 23, 2020
Published online: November 6, 2020
Processing time: 178 Days and 3.3 Hours
Abstract
BACKGROUND

Many classification systems of thoracolumbar spinal fractures have been proposed to enhance treatment protocols, but none have achieved universal adoption.

AIM

To develop a new patient scoring system for cases with thoracolumbar injury classification and severity score (TLICS) = 4, namely the load-sharing thoracolumbar injury score (LSTLIS).

METHODS

Based on thoracolumbar injury classification and severity score, this study proposes the use of the established load-sharing classification (LSC) to develop an improved classification system (LSTLIS). To prove the reliability and reproducibility of LSTLIS, a retrospective analysis for patients with thoracolumbar vertebral fractures has been conducted.

RESULTS

A total of 102 cases were enrolled in the study. The scoring trend of LSTLIS is roughly similar as the LSC scoring, however, the average deviation based on the former method is relatively smaller than that of the latter. Thus, the robustness of the LSTLIS scoring method is better than that of LSC. LSTLIS can further classify patients with TLICS = 4, so as to assess more accurately this particular circumstance, and the majority of LSTLIS recommendations are consistent with actual clinical decisions.

CONCLUSION

LSTLIS is a scoring system that combines LSC and TLICS to compensate for the lack of appropriate inclusion of anterior and middle column compression fractures with TLICS. Following preliminary clinical verification, LSTLIS has greater feasibility and reliability value, is more practical in comprehensively assessing certain clinical circumstances, and has better accuracy with clinically significant guidelines.

Keywords: Retrospective analysis; Thoracolumbar fractures; Load-sharing classification; Thoracolumbar injury classification and severity score; Scoring system; Clinical protocols

Core Tip: Many classification systems of thoracolumbar spinal fractures have been proposed to facilitate communication among clinicians and to enhance treatment protocols. But none have achieved universal adoption. Patients with thoracolumbar injury classification and severity score of 4 can choose conservative treatment or surgery, since no objective criteria are available and subjective selectivity is ambiguous. Therefore, it is urgent to establish a unified, reliable, and reproducible classification system to guide clinical practice in thora-columbar fractures. Based on prior literature, clinical experience, expert consultations, and retrospective analysis, the present study has developed a modified patient scoring system for cases with thoracolumbar injury classification and severity score of 4, namely the load-sharing thoracolumbar injury score.