Clinico radiological outcomes of thoracolumbar vertebral fractures: insights from a regional Indian cohort

Authors

  • Aniket Bandyopadhyay Hassan Institute of Medical Sciences, Hassan, Karnataka, India
  • Lakshmeesha Thammegowda Hassan Institute of Medical Sciences, Hassan, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261221

Keywords:

TLICS, ASIA impairment scale, Kyphotic angle, Compression fracture, Burst fracture

Abstract

Background: Thoracolumbar fractures are one of the frequent spinal injuries especially in the developing areas where road accidents and occupational trauma are common. Their resource management in resource constrained health care setting is a special challenge. The paper is an evaluation of short-term (6 months) clinic radiological prognoses of patients with thoracolumbar fractures compared to clinical recovery as per radiological parameters in conventional conservative and surgical interventions.

Methods: This prospective observational study included 30 patients (26 males, 4 females) with traumatic thoracolumbar fractures treated between January 2023 and June 2024 at Hassan Institute of Medical Sciences. Patients were assessed using the American Spinal Injury Association (ASIA) spine chart, ASIA Impairment Scale (AIS), and radiological tools (X-rays, CT, MRI, and Thoracolumbar Injury Classification and Severity Score – TLICS). Surgical intervention was indicated for TLICS ≥5, progressive neurological deficits, or >50% vertebral height loss, whereas TLICS ≤3 were managed conservatively. Outcomes were followed up at admission, 7 days, 6 weeks, 12 weeks, and 24 weeks.

Results: Short-term clinic radiological evaluation demonstrates that individualized management—guided by TLICS and ASIA parameters—achieves satisfactory recovery in thoracolumbar fractures. Conservative management remains effective for stable injuries, while surgical stabilization provides structural benefits in unstable fractures. Larger multicentric studies with extended follow-up are needed to validate these findings.

Conclusions: The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.

 

References

Zileli M, Sharif S, Fornari M. Incidence and epidemiology of thoracolumbar spine fractures: WFNS spine committee recommendations. Neurospine. 2021;18(4):704-12.

Nekhlopochyn OS, Verbov VV, Verbovska SA, Cheshuk IV. Meta-analysis of the frequency of thoracolumbar junction fractures in the context of traumatic spinal injuries in the adult population. Pain Joints Spine. 2024;14(2):61-8.

Wood KB, Li W, Lebl DS, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145-64.

Aleem IS, DeMarco D, Drew B, Sancheti P, Shetty V, Dhillon M, et al. The burden of spine fractures in India: a prospective multicenter study. Glob Spine J. 2017;7(4):325-33.

Khurjekar K, Hadgaonkar S, Kothari A, Raut R, Krishnan V, Shyam A, et al. Demographics of thoracolumbar fracture in Indian population presenting to a tertiary level trauma centre. Asian Spine J. 2015;9(3):344-51.

Ambulgekar RK, Ghag NS. Epidemiological study of thoracolumbar spine fracture patients reported to tertiary care center of central India. Int J Res Orthop. 2023;9(2):261-5.

Ministry of Road Transport and Highways. Annual Report 2021-22. 2022. Available at: https://morth.nic.in/annual-report-2021-22. Accessed on 21 January 2026.

Sangondimath G, Das K, Varma K. Thoracolumbar fractures: Nonsurgical versus surgical treatment. Indian Spine J. 2018;1(2):79-85.

Avilés C, Flores S, Molina M. Conservative versus operative treatment for thoracolumbar burst fractures without neurologic deficit. Medwave. 2016;e6383.

Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine. 2013;38(23):2028-37.

Wang J, Liu P. Analysis of surgical approaches for unstable thoracolumbar burst fracture: minimum of five-year follow-up. J Paki Med Assoc. 2015;65(2):201-5.

Longo UG, Loppini M, Petrillo S, Berton A, Maffulli N, Denaro, V. Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach?. Br Med Bull. 2015;115(1):57-66.

Pereira-Duarte M, Gagliardi M, Carazzo CA, Camino-Willhuber G, Gotfryd A, Rogers M, et al. Comparison of complication rates between anterior versus posterior approaches for treating unstable Hangman's fracture. A systematic review and meta-analysis. World Neurosurg X. 2024;21:100245.

Zhang W, Li H, Zhou Y, Wang J, Chu T, Zheng W, et al. Minimally Invasive Posterior Decompression Combined with Percutaneous Pedicle Screw Fixation for the Treatment of Thoracolumbar Fractures with Neurological Deficits: A Prospective Randomized Study: Versus: Traditional Open Posterior Surgery. Spine. 2016;41:B23-9.

Head J, Rymarczuk G, Stricsek G, Velagapudi L, Maulucci C, Hoelscher C, et al. Ossification of the posterior longitudinal ligament: surgical approaches and associated complications. Neurospine. 2019;16(3):517-24.

Joaquim AF, De Almeida Bastos DC, Jorge Torres HH, Patel AA. Thoracolumbar injury classification and injury severity score system: a literature review of its safety. Glob Spine J. 2016;6(1):80-5.

Upendra B, Mahesh B, Sharma L, Khandwal P, Ahmed A, Chowdhury B, et al. Correlation of outcome measures with epidemiological factors in thoracolumbar spinal trauma. Indian J Orthop. 2007;41(4):290-5.

Satheesh KS. A study of fracture patterns and preventive strategies of thoracolumbar spine injuries. Int J Contemp Med Res. 2020;7(2):B1-5.

Parajuli B, Kayastha S, Thapa J, Shrestha D. Traumatic Thoracic and Lumbar Spine Injury in Adult Population Presenting to a Tertiary Care Hospital. J Nepal Health Res Counc. 2022;20(2):392-8.

Bhattacharya B, Maung A, Schuster K, Davis KA. The older they are the harder they fall: injury patterns and outcomes by age after ground level falls. Injury. 2016;47(9):1955-9.

Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop. 2015;49(1):72-82.

Bagga RS, Goregaonkar AB, Dahapute AA, Muni SR, Gokhale S, et al. Functional and radiological outcomes of thoracolumbar traumatic spine fractures managed conservatively according to Thoracolumbar Injury Severity Score. J Craniovertebral JU. 2017;8(4):369-73.

Pehlivanoglu T, Turgut A, Serkan B, Emre M, Mustafa O, Murat K, et al. Conservative versus operative treatment of stable thoracolumbar burst fractures in neurologically intact patients: is there any difference regarding the clinical and radiographic outcomes?. Spine. 2020;45(7):452-8.

Chou TY, Tsuang FY, Hsu YL, Chai CL. Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis. Glob Spine J. 2024;14(2):740-9.

Bakhsheshian J, Dahdaleh NS, Fakurnejad S, Scheer JK, Smith ZA. Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nonoperative management. Neurosurg Focus. 2014;37(1):E1.

Dawkins RL, Miller JH, Menacho ST, Ramadan OI, Lysek MC, Kuhn EN, et al. Thoracolumbar injury classification and severity score in children: a validity study. Neurosurgery. 2019;84(6):E362-7.

Nataraj A, Jack AS, Ihsanullah I, Nomani S, Kortbeek F, Fox R. Outcomes in thoracolumbar burst fractures with a thoracolumbar injury classification score (TLICS) of 4 treated with surgery versus initial conservative management. Clin Spine Surg. 2018;31(6):E317-21.

Metcalf T, Paulson AE, Sborov KD, Moore-Lotridge SN, Schoenecker JG, Mencio GA, et al. The Thoracolumbar Injury Classification and Severity Score Appropriately Predicts Treatment in Children Aged 10 and Under. Spine. 2024.

Choi HJ, Kim HS, Nam KH, Cho WH, Choi BK, Han IH. Applicability of thoracolumbar injury classification and severity score to criteria of Korean health insurance review and assessment service in treatment decision of thoracolumbar injury. J Korean Neurosurg Soc. 2015;57(3):174-7.

Joaquim AF, Lawrence B, Daubs M, Brodke D, Tedeschi H, Vaccaro AR, et al. Measuring the impact of the Thoracolumbar Injury Classification and Severity Score among 458 consecutively treated patients. J Spinal Cord Med. 2014;37(1):101-6.

Joaquim AF, Daubs MD, Lawrence BD, Brodke DS, Cendes F, Tedeschi H, et al. Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients. The Spine J. 2013;13(12):1760-5.

Gonzales-Portillo GS, Mamaril-Davis JC, Riordan K, Avila MJ, Aguilar-Salinas P, Burket A, et al. Evaluation of the Thoracolumbar Injury Classification and Severity (TLICS) Score Over a Two-Year Period at a Level One Trauma Center. Cureus. 2023;15(8).

Khil EK, Choi I, Lee KY, Kim YW. Can conservative treatment be effective for thoracolumbar injuries patients with TLICS scores of 4 or 5? An analysis of initial radiological findings and clinical risk factors for treatment failure. BMC Musculoskelet Disord. 2024;25(1):431.

Tan T, Huang MS, Rutges J, Marion TE, Fitzgerald M, Hunn MK, et al. Rate and predictors of failure in the conservative management of stable thoracolumbar burst fractures: a systematic review and meta-analysis. Glob Spine J. 2022;12(6):1254-66.

Hitchon PW, Abode-Iyamah K, Dahdaleh NS, Shaffrey C, Noeller J, He W, et al. Nonoperative management in neurologically intact thoracolumbar burst fractures: clinical and radiographic outcomes. Spine. 2016;41(6):83-9.

Alpantaki K, Bano A, Pasku D, Mavrogenis AF, Papagelopoulos PJ, Sapkas GS, et al. Thoracolumbar burst fractures: a systematic review of management. Orthopedics. 2010;33(6):422-9.

Sansur CA, Shaffrey CI. Diagnosis and management of low lumbar burst fractures. Semin Spine Surg. 2010;22(1):33-7.

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Published

2026-04-27

How to Cite

Bandyopadhyay, A., & Thammegowda, L. (2026). Clinico radiological outcomes of thoracolumbar vertebral fractures: insights from a regional Indian cohort. International Journal of Research in Orthopaedics, 12(3), 711–722. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261221

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Original Research Articles