Thoracolumbar spine trauma classification: the Thoracolumbar Injury Classification and Severity Score system and case examples

Clinical article

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Object

The aim of this study was to review the Thoracolumbar Injury Classification and Severity Score (TLICS) and to demonstrate its application through a series of spine trauma cases.

Methods

The Spine Trauma Study Group collaborated to create and report the TLICS system. The TLICS system is reviewed and applied to 3 cases of thoracolumbar spine trauma.

Results

The TLICS system identifies 3 major injury characteristics to describe thoracolumbar spine injuries: injury morphology, posterior ligamentous complex integrity, and neurological status. In addition, minor injury characteristics such as injury level, confounding variables (such as ankylosing spondylitis), multiple injuries, and chest wall injuries are also identified. Each major characteristic is assigned a numerical score, weighted by severity of injury, which is then summated to yield the injury severity score. The TLICS system has demonstrated initial success and its use is increasing. Limitations of the TLICS system exist and, in some instances, have yet to be addressed. Despite these limitations, the severity score may provide a basis to judge spinal stability and the need for surgical intervention.

Conclusions

By addressing both the posterior ligamentous integrity and the patient's neurological status, the TLICS system attempts to overcome the limitations of prior thoracolumbar classification systems. The TLICS system has demonstrated both validity and reliability and has also been shown to be readily learned and incorporated into clinical practice.

Abbreviations used in this paper: AO = Arbeitsgemeinschaft für Osteosynthesefragen; ASIA = American Spinal Injury Association; PLC = posterior ligamentous complex; TLICS = Thoracolumbar Injury Classification and Severity Score.

Article Information

Address correspondence to: Alpesh A. Patel, M.D., Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah 84108. email: alpesh.patel@hsc.utah.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 1. Images obtained in an 18-year-old female who sustained a fall of 10 ft off of a horse and presented with an incomplete spinal cord injury (ASIA Grade B). A: Lateral radiograph demonstrating a T10–11 dislocation. B: Sagittal CT scan demonstrating dislocation with associated fractures of the vertebral body and posterior elements. C: Sagittal T2-weighted MR image reveals compression on the spinal cord from the spinal deformity and disruption of the posterior ligamentous structures.

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    Case 2. Images obtained in a 42-year-old male involved in a high-speed motor vehicle collision who presented with back pain but no neurological deficits. A: Sagittal CT scan reveals a T-12 burst fracture with no kyphotic or translational deformity. B: Axial CT scan demonstrates T-12 fracture retropulsion and 20% canal stenosis. C: Sagittal T2-weighted MR image demonstrates intact posterior ligamentous structures with no increased signal intensity.

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    Case 3. Images obtained in a 23-year-old male who presented after a 25-ft fall out of a tree with resulting back pain and an incomplete cauda equina injury. A: Sagittal CT scan demonstrates an L-2 burst fracture. B: Axial CT scan showing the burst pattern at L-2 with 90% canal stenosis. C: Sagittal T2-weighted MR image demonstrates compression of the cauda equina and possible signal change in the PLC.

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    Images obtained in a 68-year-old male with ankylosing spondylitis who was involved in a ground-level fall and subsequently presented with back pain and normal neurological examination results. A: Sagittal CT scan demonstrates a T9–10 distraction injury with anterior, middle, and posterior column involvement (arrows). B: Sagittal STIR MR image demonstrates an increased signal at the level of the fracture but intact ligamentous structures. C: Sagittal T2-weighted MR image demonstrates no anatomical disruption of the PLC.

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