A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status.
METHODS
A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management.


OBJECTIVE
To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care and surgical treatment approach in unstable injury patterns.


BACKGROUND
The most appropriate classification of traumatic TL spine injuries remains controversial. Systems currently in use can be cumbersome and difficult to apply. None of the published classification schemata is constructed to aid with decisions in clinical management.


METHODS
Clinical spine trauma specialists from a variety of institutions around the world were canvassed with respect to information they deemed pivotal in the communication of TL spine trauma and the clinical decision-making process. Traditional injury patterns were reviewed and reconsidered in light of these essential characteristics. An initial validation process to determine the reliability and validity of an earlier version of this system was also undertaken.


RESULTS
A new classification system called the Thoracolumbar Injury Classification and Severity Score (TLICS) was devised based on three injury characteristics: 1) morphology of injury determined by radiographic appearance, 2) integrity of the posterior ligamentous complex, and 3) neurologic status of the patient. A composite injury severity score was calculated from these characteristics stratifying patients into surgical and nonsurgical treatment groups. Finally, a methodology was developed to determine the optimum operative approach for surgical injury patterns.


CONCLUSIONS
Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.
Vaccaro
Alexander R
AR
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA. alexvaccaro3@aol.com
Lehman
Ronald A
RA
Hurlbert
R John
RJ
Anderson
Paul A
PA
Harris
Mitchel
M
Hedlund
Rune
R
Harrop
James
J
Dvorak
Marcel
M
Wood
Kirkham
K
Fehlings
Michael G
MG
Fisher
Charles
C
Zeiller
Steven C
SC
Anderson
D Greg
DG
Bono
Christopher M
CM
Stock
Gordon H
GH
Brown
Andrew K
AK
Kuklo
Timothy
T
Oner
F C
FC
D006801:Humans; D017846:Longitudinal Ligaments / Q000000981:diagnostic imaging* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D009420:Nervous System / Q000503:physiopathology*; D012720:Severity of Illness Index; D013124:Spinal Injuries / Q000145:classification* / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000293:injuries*; D014057:Tomography, X-Ray Computed