Overview
This lecture discusses thoracolumbar injury classification systems, focusing on the TLICS (Thoracolumbar Injury Classification and Severity Score) and AO Spine criteria, to guide management decisions for spinal trauma.
TLICS (Thoracolumbar Injury Classification and Severity Score)
- TLICS is a grading scale to determine the urgency and need for surgical intervention in thoracolumbar spine injuries.
- The score is based on three factors: posterior ligamentous complex (PLC) integrity, fracture morphology, and neurologic status.
- PLC includes ligamentum flavum, facet capsule, intraspinous ligament, and supraspinous ligament; disruption implies instability.
- Fracture types like burst or distraction injuries often indicate PLC involvement and instability.
- Neurologic evaluation considers intact, incomplete, or complete spinal cord injury, and cauda equina syndrome.
- Higher TLICS scores favor surgery, lower scores may allow conservative management.
- TLICS should be applied at the time of initial assessment, not repeated.
AO Spine Classification System
- AO Spine focuses on radiographic morphology of thoracolumbar injuries.
- Type A: Compression injuries involving just the anterior column, generally stable.
- Type B: Distraction injuries disrupting the posterior (tension band) elements.
- Type C: Fracture-dislocations, always unstable and require surgery.
- The system aids communication, research, and standardizes trauma descriptions.
- Subtypes A0 to A4 indicate increasing severity (A0 = insignificant, A4 = complete burst with both endplates).
- A2-type fractures are unlikely to heal well and commonly need surgery; A3 may be managed conservatively depending on patient factors; A4 usually needs surgery.
Assessment and Management Tips
- Always prioritize identifying the most severe injury first (e.g., complete burst fracture).
- Weight-bearing (upright) x-rays are essential before discharge to assess real alignment and stability.
- Patients must have upright x-rays (with collar if applicable) before leaving trauma services, as supine imaging may miss instability.
- Upright imaging is critical for understanding likely healing and guiding conservative vs surgical management.
Key Terms & Definitions
- TLICS — Thoracolumbar Injury Classification and Severity Score; a clinical tool for decision-making.
- PLC (Posterior Ligamentous Complex) — Ligaments stabilizing the back part of the spine.
- AO Spine Classification — System classifying thoracolumbar fracture morphology (types A, B, C).
- Burst Fracture — Vertebral fracture with disruption of the posterior cortex, may cause spinal canal compromise.
- Distraction Injury — Injury separating spinal segments, usually involving ligament disruption.
- ASIA Scale — Neurologic assessment scale, accurately performed 48–72 hours post-injury.
Action Items / Next Steps
- Ensure all spinal trauma patients receive upright/weight-bearing x-rays before discharge.
- Review TLICS and AO Spine classification criteria and practice applying them to radiographic cases.
- Read about the ASIA scale assessment for spinal cord injury evaluation.