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Spine Fracture Classification Scoring System Found Valid

New numeric Thoracolumbar Injury Severity Score may effectively guide management decisions

WEDNESDAY, May 26 (HealthDay News) -- A novel system for the classification of spinal fractures, which produces a numeric score to guide the management approach, appears to consistently suggest treatment in keeping with past treatment recommendations, according to a retrospective study in the May issue of the Journal of Spinal Disorders & Techniques.

Christopher J. Lenarz, M.D., and Howard M. Place, M.D., of Saint Louis University Hospital, reviewed the clinical information for 97 consecutive cases of traumatic thoracolumbar fracture, and, after all personal identifiers had been removed, re-evaluated each case using the Thoracolumbar Injury Severity Score (TLISS) classification system, which numerically grades the mechanistic features of the fractures and neurological status of the patient to produce a score to guide management. The researchers compared the TLISS recommendations to the actual clinically determined management in each case.

Of the 97 patients, the researchers found that 81 had received management consistent with the TLISS, while seven patients received management inconsistent with the TLISS. Four of the seven had received scores indicating surgery but were managed conservatively, while three whose score indicated conservative management had an operation. Nine patients had the mid-level indeterminate score of four. Multilevel contiguous fractures and extension injuries in the ankylosed thoracic spine were the injury types most often treated inconsistently with TLISS recommendations.

"Our retrospective study supports using the TLISS in the initial management of spinal fractures. We believe that the numerical grading system is a reasonable starting point to guide treatment," the authors write.

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