Vertebral fractures of the
thoracic vertebrae,
lumbar vertebrae or
sacrum are usually associated with major trauma and can cause
spinal cord injury that results in a
neurological deficit.
Thoracolumbar injury classification and severity score The thoracolumbar injury classification and severity score (TLICS) is a
scoring system to determine the need to surgically treat a spinal fracture of thoracic or lumbar vertebrae. The score is the sum of three values, each being the score of the most fitting alternative in three categories:
Injury type • Compression fracture - 1 point • Burst fracture - 2 points • Translational rotational injury - 3 points • Distraction injury - 4 points
Posterior ligamentous complex • Intact - 0 points • Suspected injury or indeterminate - 2 points • Injured - 3 points
Neurology • Intact - 0 points •
Spinal nerve root injury - 2 points • Incomplete injury of cord/
conus medullaris - 3 points • Complete injury of cord/conus medullaris (complete) - 2 points •
Cauda equina syndrome - 3 points A TLICS score of less than 4 indicates non-operative treatment, a score of 4 indicates that the injury may be treated operatively or non-operatively, while a score of more than 4 means that the injury is usually considered for operative management. is the most recent classification scheme for thoracolumbar injuries. ATLICS is broadly based on the TLICS system and has sufficient reliability irrespective of the experience of the observer. ATLICS is primarily focused on fracture morphology, and has two additional sections addressing the neurological grading and clinical modifiers:
Fracture morphology • Type A: Compression injuries (sub-types A0-A4) • Type B: Distraction injuries (sub-types B1-B3) • Type C: Translation injuries
Neurological status • N0: neurologically intact • N1: transient deficit • N2: radiculopathy • N3: "incomplete spinal cord injury or cauda equina injury" • N4: "complete spinal cord injury" • NX: unknown neurological status
Modifiers • M1: unknown tension band injury status • M2: comorbidities == Osteoporotic vertebral compression fracture ==