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Abstract：
BACKGROUND: This study aimed to assess the outcomes of conservative management in patients with thoracolumbar fractures classified with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4 or 5, and to analyze initial imaging findings and clinical risk factors associated with treatment failure.
METHODS: In this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed.
RESULTS: The conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22-85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001-0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001-0.045 or < 0.001; with cutoff values of 18.2, 12.8, and 7.8%, respectively), and lower anterior wall height (p = 0.001), demonstrating good to excellent interobserver agreement (0.72-0.99, p < 0.001). Furthermore, osteoporosis was identified as a significant risk factor (odds ratio = 5.64, p = 0.008).
CONCLUSIONS: Among patients with TLICS scores of 4 or 5, those experiencing conservative treatment failure exhibited unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis. Additionally, osteoporosis emerged as a significant risk factor for treatment failure.
METHODS: In this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed.
RESULTS: The conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22-85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001-0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001-0.045 or < 0.001; with cutoff values of 18.2, 12.8, and 7.8%, respectively), and lower anterior wall height (p = 0.001), demonstrating good to excellent interobserver agreement (0.72-0.99, p < 0.001). Furthermore, osteoporosis was identified as a significant risk factor (odds ratio = 5.64, p = 0.008).
CONCLUSIONS: Among patients with TLICS scores of 4 or 5, those experiencing conservative treatment failure exhibited unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis. Additionally, osteoporosis emerged as a significant risk factor for treatment failure.
摘要：
背景：本研究旨在评估胸腰椎骨折患者保守治疗的结果，胸腰椎损伤分类和严重程度（TLICS）评分为4或5分，并分析初始影像学发现和与治疗失败相关的临床风险因素。
方法：在本回顾性分析中，纳入了2017年1月至2020年12月通过MRI确定的TLICS评分为4或5分的胸腰椎骨折患者.接受保守治疗的患者分为两组：第1组（治疗成功）和第2组（治疗失败），基于初始和6个月的随访结果。比较两组患者的临床资料。最初的放射学评估包括三个后凸测量（Cobb角，加德纳角,和矢状指数[SI])，前壁和后壁高度，和中央运河妥协（CC）。此外,分析导致治疗失败的危险因素.
结果：保守治疗组包括84名患者（平均年龄，60.25±15.53；范围22-85；42名男性），第1组57人，第2组27人。第二组女性比例较高，年龄较大,和较低的骨密度（p=0.001-0.005）。第2组的初始影像学发现显示Cobb角值明显更大，SI,和CC(p=0.001-0.045或<0.001；截止值为18.2、12.8和7.8%，分别)，和较低的前壁高度（p=0.001），表现出良好的观察者间一致性(0.72-0.99，p<0.001)。此外，骨质疏松被认为是一个显著的危险因素(比值比=5.64,p=0.008).
结论：在TLICS评分为4或5的患者中，保守治疗失败的患者表现出不利的初始放射学发现，女性比例更高，高龄,和骨质疏松症。此外,骨质疏松症成为治疗失败的重要危险因素.
方法：在本回顾性分析中，纳入了2017年1月至2020年12月通过MRI确定的TLICS评分为4或5分的胸腰椎骨折患者.接受保守治疗的患者分为两组：第1组（治疗成功）和第2组（治疗失败），基于初始和6个月的随访结果。比较两组患者的临床资料。最初的放射学评估包括三个后凸测量（Cobb角，加德纳角,和矢状指数[SI])，前壁和后壁高度，和中央运河妥协（CC）。此外,分析导致治疗失败的危险因素.
结果：保守治疗组包括84名患者（平均年龄，60.25±15.53；范围22-85；42名男性），第1组57人，第2组27人。第二组女性比例较高，年龄较大,和较低的骨密度（p=0.001-0.005）。第2组的初始影像学发现显示Cobb角值明显更大，SI,和CC(p=0.001-0.045或<0.001；截止值为18.2、12.8和7.8%，分别)，和较低的前壁高度（p=0.001），表现出良好的观察者间一致性(0.72-0.99，p<0.001)。此外，骨质疏松被认为是一个显著的危险因素(比值比=5.64,p=0.008).
结论：在TLICS评分为4或5的患者中，保守治疗失败的患者表现出不利的初始放射学发现，女性比例更高，高龄,和骨质疏松症。此外,骨质疏松症成为治疗失败的重要危险因素.
