Progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the Achilles tendon of the Thoracolumbar Injury Classification and Severity Score (TLICS)

摘要: The Thoracolumbar Injury Classification and Severity (TLICS) scale has been considered one of the best available grading systems for evaluating thoracolumbar fractures, especially due to fact that, differently from previous classifications, it can be used as a practical algorithm orient clinical decision-making between conservative surgical management. authors describe case 54-year-old patient presenting with low-back pain after having struck her back on handrail. neurological exam was unremarkable. CT-scan lumbar spine demonstrated L1 comminuted burst fracture. MRI no evidence posterior ligamentous complex injury. According TLICS classification (total score 2) managed conservatively brace. Although at 1-month follow-up X-rays major changes had clinically improved, lost follow-up. After 12 months presented emergency department complaints increased pain. repeat remarkable worsening vertebral body fracture, kyphotic deformity. submitted staged anterior–posterior procedure consisting in decompression T12–L2 levels, T10–L4 pedicle screw fixation and, finally, lateral transpsoas approach corpectomy reconstruction an expandable interbody cage plate fixation. At 6-months follow-up, another episode new L4 endplate fracture identified. 2 months failed treatment, treated percutaneous kyphoplasty. 12-months initial procedure, free stable radiographs. In this Grand Rounds presentation, perform comprehensive discussion about historical developments fractures special emphasis system. such presents several advantages relation other systems, patients deserve attention, even if initially classified non-operative according algorithm. cases, decision management is taken, close recommended high likelihood long-term