Review Question - QID 7666

The patient has a stable L2 burst fracture. There is no evidence of neurologic injury or disruption of the posterior ligamentous complex. According to the Thoracolumbar Injury Classification System (TLICS), the severity score for this injury is 2 and therefore nonsurgical management is recommended. The TLICS was developed to define injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. Point values are assigned to each major category based on injury severity. The sum of these points represents the TLICS severity score, which may be used to guide treatment. The injury scores are totaled to produce a management grade that is, in turn, used to guide treatment. A score of >4 suggests the need for surgical treatment because of significant instability, whereas a score of <4 suggests nonsurgical management. The severity score offers prognostic information and is helpful in medical decision making. An external orthosis provides enough support to obviate the need for bed rest and avoid associated complications (deep venous thrombosis, pulmonary embolism, pneumonia, skin ulceration). Surgical treatment, either through an anterior or posterior approach, has been shown by Wood and associates to result in increased pain and disability and is therefore not indicated in this setting. Additionally, there is no need for decompression in the setting of a neurologically intact patient.