Review Question - QID 213185

All the variables listed are used to calculate the Thoracolumbar Injury Classification and Severity (TLICS) score except for percent spinal canal compromise.

The TLICS score is designed to help guide the treatment of thoracolumbar fractures, namely burst fractures. A score is assigned for the following categories: 1. Injury morphology, 2. Neurologic status, and 3. Posterior ligamentous complex integrity. The classification system is unique in that it places significant emphasis on stability as determined by the posterior ligamentous complex, which is classified as intact, suspect/indeterminant, or disrupted. Clear evidence of PLC disruption includes widening of interspinous process distance, fractures of the spinous process (Chance fx), and displaced fractures of the facets and lamina. Flexion stress radiographs under physician supervision may help identify disruption of the PLC.

Vaccaro et al. introduced TLICS, a new classification system for thoracolumbar injuries based on morphological appearance, the integrity of the posterior ligamentous complex, and neurological status. They advocate the use of the system for nonoperative versus operative decision-making and communication between surgeons.

Vaccaro et al. sought to determine the accuracy of magnetic resonance imaging (MRI) in diagnosing injury of the posterior ligamentous complex (PLC) in patients with thoracolumbar trauma. Forty-two patients with 62 levels of injury were studied. The sensitivity for the various PLC components ranged from 79% (left facet capsule) to 90% (interspinous ligament). The specificity ranged from 53% (thoracolumbar fascia) to 65% (ligamentum flavum).

Wood et al. (2003 and 2018) performed a prospective RCT showing the 4-year and long-term (16-22 years) results of operative versus nonoperative treatment of patients with a thoracolumbar burst fracture with no neurologic deficits. They found that early analysis (four years) revealed few significant differences between the two groups; however, at long-term follow-up (sixteen to twenty-two years), those with a stable burst fracture who were treated nonoperatively reported less pain and better function compared with those who were treated surgically.

Illustration A shows the table to calculate TLICS score. Illustration B shows the concept of distraction of the PLC leading to a spinous process fracture. Illustration C is a CT scan showing a burst fracture with a distraction spinous process fracture (bony Chance fx), indicating disruption of the PLC. Illustration D is a CT scan showing a burst fracture with a lamina fracture, indicating disruption of the PLC.

Incorrect Answers:
Answers 2-5: Each of these variables is used to calculate the TLICS score.