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    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
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    Patent Pending

    Thoracolumbar Injury Classification and Severity Scale (TLICS)

    Classifies thoracolumbar spine injury and provides treatment recommendations.
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    INSTRUCTIONS

    Requires appropriate imaging (at least CT) to determine posterior instability for accurate interpretation.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with thoracolumbar fracture involving vertebral body, pars, or pedicle, and any significant ligamentous injury.

    • Make sure to have appropriate imaging to evaluate the posterior column. On CT, look for widened facet joints and interspinous spaces. If posterior columns are not visualized on CT, then MRI is required.

    • If a patient has a neurological deficit, it is strongly advised to carefully review films to help determine if decompression would be beneficial to the patient.
    • Consider patient’s comorbidities and other underlying pathologies that may have predisposed the patient to injury, e.g. osteopenia/osteoporosis, infection, malignancy.

    Intuitive, evidence-based method for determining spinal instability.

    Compression fracture
    +1
    Burst fracture
    +2
    Translational/rotational
    +3
    Distraction
    +4
    None of the above
    0
    Intact
    0
    Nerve root
    +2
    Complete cord
    +2
    Incomplete cord
    +3
    Cauda equina
    +3
    Intact
    0
    Injury suspected or indeterminate
    +2
    Injured
    +3

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Surgical decision-making is multifactorial and no single score should be used to make the decision to operate or not. Use in conjunction with clinical judgment.

    • This system is designed to assist in stabilization.

    • Decompression may also be needed with or without neurological deficit. Use best clinical judgment for decompression.

    Management

    Recommendations:

    • 0-3 points: Non-operative treatment (brace).

      • Patients with neurological deficit may still need decompression but may be stable and not need instrumentation.

    • 4 points: Non-operative or operative treatment (surgeon’s choice).

      • A bracing trial can be conducted to verify stability with upright x-rays.

      • Stabilization should be considered in patient with severe axial back pain once they become weight bearing.

    • ≥5 points: Operative treatment (stabilize).

      • Patient should be stabilized due to spinal instability from trauma.

      • If appropriate, fracture reduction should be performed at the time of stabilization.

    Bracing is typically performed by a variety of orthotic devices, such as:

    • TLSO: T6-L5.

    • Minerva: C1-T6.

    • Jewett hyperextension brace: T5-T9.

    Stabilization can be performed using:

    • Posterior pedicle screw constructs.

    • Anterior or lateral corpectomy with cage placement and vertebral body plating.

    • Posterior lateral approaches to allow for corpectomy and expanding cage placement.

    Critical Actions

    If a patient has a neurological deficit, it is strongly advised to carefully review films to help determine if decompression would be beneficial to the patient.

    Content Contributors
    • Christopher Storey, MD, PhD
    About the Creator
    Dr. Joon Y. Lee
    Are you Dr. Joon Y. Lee?
    Content Contributors
    • Christopher Storey, MD, PhD