Surgical Intervention Does Not Promote Early Mobilization in Thoracolumbar Fractures with Thoracolumbar Injury Classification and Severity Scores (TLICS) Less than Four

Introduction:
Thoracolumbar fractures are a common occurrence in trauma activations. These fractures can be classified in various ways, aiding in assessing when surgical intervention is required. One such classification system is the Thoracolumbar Injury Classification and Severity (TLICS) score. Typically, conservative treatment is indicated in patients with scores less than four, but some are treated surgically due to a lack of mobilization, pain, instability, and new neurologic deficits. There exists a paucity of literature examining intrahospital mobilization for patients with TLICS < 4 treated operatively.

Objective:
The purpose of this study was to compare intrahospital mobilization and discharge disposition for patients with a Thoracolumbar Fractures with Thoracolumbar Injury Classification and Severity Scores (TLICS) less than four treated surgically compared to those treated conservatively.

Methods:
This was a retrospective cohort study at a single level one trauma center. 274 patients presenting with thoracolumbar fractures between January 1,2016- December 2020 were screened, finding 79 patients with TLICS < 4 meeting inclusion criteria (21 surgical, 58 non-surgical). Demographic, TLICS score, intrahospital physical therapy (PT) data, and discharge disposition were evaluated. Specific PT data included the number of days until the patient had a chair transfer in which the patient did >50% on their own, days until they ambulated any distance, days until the patient ambulated >50% on their own, and ambulation distance on last day of PT. Descriptive tests, Chi-squared analysis, and T-tests were used for analysis.

Results:
Patient demographics were similar between the two groups. When comparing the surgically treated group to the conservatively treated group, the focus was on mobilization in the days after surgery compared to the days after admission. When considering days to ambulate, there was no difference found between the two groups (2.8 vs 2.7 days, p>.05). Additionally, no significant difference exists for the days until achieving a chair transfer in which the patient did >50% on their own (2.8 vs. 2.4 days, p>.05). Days until the patient ambulated >50% on their own also did not differ significantly (2.8 vs. 2.7 days, p>.05). Following operative treatment, more patients have to be discharged to rehab centers.

Conclusion:
This study found no statistically significant difference in ambulation after surgery for patients with TLICS < 4 undergoing surgical treatment compared to following admissions for patients with TLICS < 4 treated conservatively. Accordingly, there is no significant advantage to operating on patients with TLICS < 4 if they are mobilizing well in the days following admission. Mobilization following spine surgery and injury has previously been established as improving functional outcomes. Therefore, for patients with TLICS < 4 not ambulating operative intervention may allow them to mobilize comparably to those treated conservatively and should be considered. Limitations of this study include the lack of PT notes from everyday patients with thoracolumbar fractures were in the hospital and the relatively small size of the study population. Further studies are needed to examine mobilization differences between the two groups before the surgical group undergoes surgical intervention, in the period after discharge, and to compare long-term outcomes between the two groups.