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Spine Rapid Fire Abstract

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Conservative versus Surgical Management in Patients with Thoracolumbar Injury of TLICS Score 4: A Systematic Review and Meta-Analysis

Saturday, May 4, 2024
3:39 PM – 3:41 PM CT
Location:  S403ab
Disclosure(s):
Ahmed Noor: No financial relationships to disclose
Karim R. Nathani, MBBS: No financial relationships to disclose
Introduction: To assess the comparative efficacy of conservative and surgical management in patients with a TLICS score of 4, specifically focusing on return to work (in days) and Visual Analog Scale (VAS) scores as primary outcomes.

Methods: A systematic search of major databases was conducted, covering the period from January 2008, to June 30, 2022. Two independent reviewers assessed the level of evidence quality using the set criteria and disagreements were resolved by consensus. Pooled mean differences (MD) with 95% confidence intervals (CIs) were calculated to compare the two treatment groups. A random-effects model was employed to account for study heterogeneity.

Results: After the removal of duplicates a total of 105 unique studies were identified on major databases (PubMed, Embase, Scopus, Web of Science, and Cochrane). Out of the 105 citations, 6 studies were shortlisted for full text review and 4 of them met the inclusion criteria. These studies collectively included 272 patients with TLICS score 4 thoracolumbar injuries. About 140 of those patients were managed conservatively and the rest 132 were treated surgically. When comparing conservative and surgical management, our meta-analysis revealed that patients in the conservative management group returned to work sooner, although the difference was not statistically significant (MD = 31.7; 95% CI [-21.72, 85.22]). VAS scores were lower in the surgical group but not significantly different (MD = -1.45; 95% CI [-3.54, 0.63]). The overall results suggest intriguing trends with potential clinical implications.

Conclusion : Our study has shown novel insights into the management of patients with a TLICS score of 4. While statistical significance was not achieved, our results indicate a bias towards conservative management as compared to surgical management with the former responsible for quicker return to work. However, further investigations are warranted. The emphasis remains on the clinical implications of these trends and the potential impact on treatment decisions.