Assessment of load-sharing thoracolumbar injury: A modified scoring system

Figure 1 Scoring sub-items of the compression in load-sharing thoracolumbar injury score. A: Comminution/involvement; B: Apposition of fragments; and C: Deformity correction (from McCormack et al[4]).

Figure 2 Score distribution analysis of 102 patients. A: This quadrant represents load-sharing thoracolumbar injury score (LSTLIS) recommended non-surgical treatment but where surgery is performed; B: This quadrant represents LSTLIS-recommended surgery, but surgery is not performed; C: This quadrant represents LSTLIS-recommended surgery, and actual surgery is performed; D: This quadrant represents LSTLIS-recommended non-surgical treatment, and hence surgery was not performed. LSC: Load-sharing classification; TLICS: Thoracolumbar injury classification and severity score.

Figure 3 Two typical cases where thoracolumbar injury classification and severity score = 4, but ultimately different clinical treatments were used. A: Typical young female patient, thoracolumbar injury classification and severity score = 4, load-sharing thoracolumbar injury score = 5.5 (Compression: C/A/D = 1/1.5/1; Nerve root injury = 2), X-ray; B: Computed tomography; C: Transverse planes of computerized tomography and magnetic resonance imaging; D: Magnetic resonance imaging: T1WI, T2WI, STIR; E: Three-dimensional reconstruction of the lumbar spine before surgery; F: Three-dimensional reconstruction of the lumbar spine after surgery.

Figure 4 Conservative treatment also resulted in a good clinical outcome. A: Typical middle-aged female patient, thoracolumbar injury classification and severity score = 4, load-sharing thoracolumbar injury score = 3.5 (Compression: C/A/D = 0.5/0.5/0.5; posterior ligamentous complex injury suspected = 2), X-ray; B: Magnetic resonance imaging: T1WI, T2WI, T2WI-FS, Transverse plane; C: Computed tomography; D: Three-dimensional reconstruction of lumbar vertebrae.