Management of Thoracolumbar Injury Classification and Severity Score (TLICS) 4 thoracolumbar fractures after natural disasters: Comparative outcomes of conservative and surgical treatments following the 2023 Türkiye earthquake

This study examines the outcomes of conservative versus surgical treatment for Thoracolumbar Injury Classification and Severity Score (TLICS) 4 thoracolumbar fractures in patients injured during the 2023 Türkiye earthquake. It aims to assess clinical and radiographic outcomes while considering the impact of crush syndrome-related complications on treatment decisions. Twenty-three patients with TLICS 4 spinal injuries were evaluated and divided into surgical (n=12) and conservative (n=11) groups. Clinical parameters, including age, gender, preoperative spinal measurements, and one-year postoperative outcomes, were assessed. The Roland-Morris score was used to evaluate clinical outcomes. Additionally, complications such as cardiac, renal, and respiratory issues, infections, and length of hospital stay were analyzed. The surgical group had significantly higher Roland-Morris scores (RM: 79.3+-12.7 vs. 15.0+-8.5, p<0.001). Preoperative acute kidney injury was more common in the conservative group (36.4% vs. 8.3%, p<0.05), whereas preoperative pulmonary complications were more frequent in the surgical group (83.3% vs. 36.4%, p<0.05). No significant differences were found in gender, age, or other complications. Radiological outcomes, including Cobb angle, sagittal index, and anterior central vertebral body height (ACVBH) restoration, showed no significant differences between groups. Length of hospital stay was similar between groups. Our study demonstrates that both conservative and surgical treatments are effective for managing TLICS 4 thoracolumbar fractures in disaster settings. Treatment decisions should be guided by patient-specific factors and available resources.