A Comparison of Thoracolumbar Injury Classification in Spine Trauma Patients Among Neurosurgeons in East Africa Versus North America
By Admin | November 27, 2022
In January 2021, we published findings evaluating the validity of thoracolumbar injury classification and biomechanical approach in the clinical outcome of operative and non-operative treatments. A notable result in our study was patients with unstable burst fractures received an Arbeitsgemeinschaft für Osteosynthesefragen System (AO) score that recommended conservative treatment compared to a Thoracolumbar Injury Classification and Severity Scale (TLICS) score that recommended surgical intervention. We designed a survey to determine reported differences in thoracolumbar injury classification, including the percentage of thoracolumbar spine fractures, type of classification system(s) used, use of classification system by board-certified neurosurgeons and neurosurgical residents, reliance on classification system to guide management, use of MRI in the evaluation of the posterior ligamentous complex, and readmission rate < 90 days at treating facilities. This study aims to determine which areas of neurosurgical practice in spine trauma patients differ among surgeons in North America and East Africa, including Ethiopia, Kenya, and Sudan. Multiple classification systems have been proposed to describe thoracolumbar spine injuries. We hypothesized that there would be marked variability in the classification systems used to evaluate thoracolumbar spine injury among neurosurgeons in North America and East Africa.
The survey consisted of seven questions and was sent to 440 neurosurgeons practicing on the continents of North America and East Africa.
A total of 67 surgeons responded, 50 from North America and 17 from East Africa, including Ethiopia, Kenya, and Sudan. A significant percentage of African respondents reported a higher thoracolumbar spine fracture rate than respondents in North America (53% and 30%, respectively). Regarding the classification system used, 65% of surgeons in East Africa reported using TLICS, whereas 62% of surgeons in North America reported using Denis 3-column classification. For patients with spine trauma, surgeons in East Africa and North America reported a similar percentage of readmission <90 days (47% and 52%, respectively).
Our findings vary in spine trauma classification for American and East African patients and still highlight crucial areas for improvement due to patient load, education, and resource accessibility.
Traumatic spine injury is a severe condition associated with everlasting disability or even mortality. Spinal injuries lead to significant physical, emotional, and financial burdens on affected individuals, families, and society. The outcome after a traumatic spinal injury is far better in developed countries than in low-income countries because of the availability of high-quality pre-hospital management, treatment, rehabilitation, and long-term support facilities for disabled patients . Such resources are generally limited in developing countries; thus, establishing medical priorities can be difficult. Information about epidemiology and outcome after spine injuries is necessary to develop appropriate prevention and treatment strategies in each country. Such information is scarce, however, in low-income countries [2-3].
We previously evaluated the validity of thoracolumbar (TL) injury classification and biomechanical approach in the clinical outcome of operative and non-operative treatments. Despite numerous methodologies for assessing patients with TL injuries with a TLICS score of 4 or a "grey zone" score, the standardized classification and treatment of TL spine injuries remain controversial. It was hypothesized that there would be variability in how patients are evaluated among treating physicians with current TL scoring systems, Arbeitsgemeinschaft für Osteosynthesefragen System (AO), and Thoracolumbar Injury Classification and Severity Score (TLICS). Our study found that patients with unstable burst fractures received an AO score that recommended conservative treatment. For example, patients without neurological deficits (n=19/37) received an AO score between 1 to 3 points in which AO recommends conservative treatment, compared to patients (n=37) who received a TLICS > 4. In the guidance of neurosurgical management, TLICS may be more reliable compared to AO recommendations in managing unstable burst fractures without neurological deficits, as the AO scoring system recommended conservative treatment in this study. However, this conclusion needs to be further...(More)
For more info please read, A Comparison of Thoracolumbar Injury Classification in Spine Trauma Patients Among Neurosurgeons in East Africa Versus North America, by Cureus