Is the Thoracolumbar Injury Severity Score (TLISS) still a good base for the education of residents in Orthopaedics and Traumatology?

ABSTRACT Introduction. Thoracolumbar spinal injuries indicated for surgical intervention specify the necessity of intervention within 24 hours. The traumatologists working in a structure without a Spinal Unit must be able to evaluate such injury and set indications for surgical treatment, that is, nonoperative treatment. The purpose of this study is to evaluate if Thoracolumbar Injury Severity Score (TLISS) is still a good base for the classification of thoracolumbar spinal injuries and to give a correct indication for nonoperative, that is, surgical treatment. Patients and Methods. Six Orthopaedics and Traumatology residents from Siena (Italy), five Orthopaedics and Traumatology residents from the Clinical Centre of Banja Luka (Bosnia and Herzegovina) and five Orthopaedics and Traumatology residents from the Alta Val d’Elsa Hospital, Siena (Italy) were presented 24 clinical cases from professional literature where the following data were indicated: patient’s age, neurological conditions, description of the injury, mechanism of the injury and radiological findings (RTG, MR). The abovementioned 24 patients were chosen from the literature based on the injuries mostly seen by an orthopaedist with a lack of experience in the problems of spinal column trauma (low energy trauma, with partial or without neurological impairments, with the TLISS score of 4). The residents from the three groups had to classify all patients according to the TLISS score and to define the most appropriate method of treatment-conservative or surgical, and after that, all classifications, as well as the therapeutic decisions, were compared. The statistical methods used in this study include: statistical significance, reliability (P<0.05), the validity of the decision, the percentage of accuracy and Cohen’s kappa coefficient. The best results in evaluation of the mechanism of the injury were demonstrated by the group of doctors from the Orthopaedic Hospital with an accuracy of 78.8% (P<0.05) and with an average correlation (K = 0.598). The best description of the injury was presented by the doctors from Siena with 87% accuracy (P<0.05) and with correlation (K=0.749). The doctors from Siena responded best at evaluating the neurological status with 97.6% accuracy (P<0.05) and with correlation (K=0.936). The assessment of the injury of the PCL residents from Siena was 64.7% accurate (P<0.05) with correlation (K=0.426). The total TLISS score was best calculated by the residents of Siena with 82% accuracy (P<0.05) and correlation (K=0.718). The most appropriate therapeutic decision was made by the residents from Siena with 80.3% accuracy (P<0.05) and with correlation (K =0.707). Conclusion. Currently, the Denis classification and the AO classification are the most widely used classification algorithms for the fractures of thoracolumbar spine but some defects have also been identified in both of them. The value of TLISS evaluation is by the three groups of residents in presented 24 patients from the professional literature. Significant differences in accuracy were found in defining a real damage of the spinal cord at the level of the cauda equina. The evaluation of the integrity of the posterior longitudinal ligament by the radiography is of low accuracy.