Most thoracolumbar injuries can be effectively treated nonsurgically.


Subset require surgical intervention to prevent future painful deformity or worsening neurological function.

Precursors

In general are of limited utility as they do not assist in decision making.  Have been critiqued by many because they do not include assessment of neurological status.

Denis

Introduced the middle column

  • mode of failure of the middle column stratified fracture types and risk of neurologic injury

Major injuries

  • Compression
  • Burst
  • Seat-belt
  • Flexion-distraction

AO

  • Most comprehensive (53 subtypes)
  • Poor interobserver and intraobserver reliability

Thoracolumbar Injury Classification and Severity Scale – TLICSS (Vaccaro et al.)

  • Modification of the Thoracolumbar Injury Severity Scale (TLISS) based on observations from the TLISS validation study.
  • Modifications to improve validity and reliability
  • Fracture mechanism category changed to fracture morphology
  • Subcategory summation discarded (previously multiple injuries within a category were summed to a total point value.)
  • Lateral compression category discarded (weak reliability)

Uses point system to guide management and is based on 3 categories: fracture morphology, neurologic status, and integrity of the posterior ligamentous complex. 

Fracture morphology (instead of mechanism as in TLISS)

  • Compression Injuries (1pt)
  • Burst (+1pt = 2pts total)
  • Translational/Rotational Injuries (3pts)
  • Distraction Injuries (4pts)

Neurologic status

  • Intact (0)
  • Root Injury (2pts)
  • Complete (2pts)
  • Incomplete (3pts)
  • Cauda Equina (3pts)

Integrity of posterior ligamentous complex (PLC)

  • Supraspinous ligament (SSL), interspinous ligament (ISL), capsular ligaments and ligamentum flavum
  • MRI is highly sensitive for injury to the SSl & ISL
  • Intact (0)
  • Injury suspected (2pts)
  • Injured (3pts)

Summation of point values from each category

  • 3 or less – nonoperative
  • 4 – either operative or nonoperative manaagement
  • 5 or more – surgical candidate