Vertebral Fracture

[Analfissure]

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When do you refer a verebral fracture to neurosurgery?

From a medicine stand point - I had felt without neurological signs, conservative approach prior to straight consultation.

Case: 70 year old with mechanical fall. CT shows T11 transverse vertebral body fracture. My attending wanted neurosurgery consultation immediately. This was at 1600 - I figured the neurosurgeon was going to roast me for the consult - but said he need immediate transfer bc its a unstable fracture. Again, the CT did mention minimal retropulsion but no mention of cord impingement in setting of neuro intact.

Opinions? What radiographic / clinical things should i be looking for to make sure i refer appropriately.

 

[kitsunepixie]

Look up TLIC score

 

[longhaul3]

If you're at my hospital, the answer is as soon as the radiologist publishes the report.

Realistically, in my experience, nobody in an academic setting is going to call a spine fracture stable without consulting us. You are making a noble effort. TLICS is the answer—a neurologically intact burst fracture usually gets an MRI because its TLICS is borderline— but in real life your attending is going to make you call us every time. If it comes in at 1500 and you call us at 1600, it is what it is, not your fault. It takes me 5 minutes to see that consult. Just don't sit on it from 0800 to 1600. But the most helpful thing is that if you understand TLICS, you can get the MRI done before you call me.

 

[Cognovi]

Does anyone use the AOSpine classification instead of TLICS? Several studies have shown better interrater reliability.