The Classification of Thoracolumbar Injury Severity Scores as Support for the Education of Trainees in Orthopedia and Traumatology

Introduction: The EBM for traumas to the thoracic lumbar spine specifies the necessity of intervention within 24 h of the trauma with a stabilization intervention when the lesion requires a surgical intervention. The Traumatologist working in a structure without a Spinal Unit must be able to evaluate traumas to the vertebral column in the Emergency Room and decide whether to direct them toward a conservative treatment or surgery. Materials and methods: Six doctors in specialized training for Orthopedics and Traumatology at the A.O.U. SENESE of Siena, five doctors specializing in Orthopedics and Traumatology at the Klinical Center of Banja Luka, Bosnia and Herzegovina, and five Orthopedics at the Val d’Elsa hospital were presented 24 clinical cases where the following details were indicated: patient age, neurological conditions, description of the injury mechanism and imaging results. The 24 cases were chosen from the literature based on the frequency with which they may present themselves before Traumatologists. The evaluation criteria of excellence indicated for statistics were: the correct arrangement of the dynamics of the event, description of the radiological picture, the TLISS Score, and the correlation of therapy with those reported in the literature. The statistical methods used were the statistical significance, the reliability (P<0.05), the validity of the decision, the percentage of accuracy, and the Cohen K. Results: The best results when evaluating the fracture mechanism were demonstrated by the Orthopedic Hospital with an accuracy of 78.8% (P<0.05) and with an average correlation (K = 0.598). The best description of the fracture was presented by the specialists from Siena with 87% accuracy (P<0.05) and an important K (0.749). The specialists of Siena responded best at evaluating the neurological status with 97.6% accuracy (P<0.05) and a perfect K (0.936). The assessment of the integrity of the LCP performed by the specialists of Siena was 64.7% accurate (P<0.05) with an intermediate K (0.426). The total TLISS score was best calculated by the specialists of Siena with 82% accuracy (P<0.05) and an important K (0.718). The most appropriate therapeutic decision was made by the specialists of Siena with 80.3% accuracy (P<0.05) and an important K (0.707). Discussion and conclusions: Currently, the Denis and the AO are the most widely used classification algorithms for TL fractures, but observational defects have been identified in both of them since reliability and repeatability have moderate values. The results outline the understanding of TLISS and the responsive capacity of the three groups evaluating the 24 case studies. Based upon test responses, it is clear that all three groups have a good overall preparation. The substantial differences between the percentages were identified in the individual accuracy in determining the actual damaged vertebral body at the level of the cauda equina.The evaluation of the integrity of the LCP using imaging was the low point of our study. The overall result of scoring the TLISS proved to be important for the future decisions of the surgeons. For theOrthopedics not specialized in the vertebral column, the discriminating factor between a surgical treatment or a conservative one was the score of TLISS = 4, which allows, when in doubt, for referring the decision to a spinal surgical specialist.