title: A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA. alexvaccaro3@aol.com
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Lehman
authors.forename: R John
authors.initials: RJ
authors.lastname: Hurlbert
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
authors.forename: Mitchel
authors.initials: M
authors.lastname: Harris
authors.forename: Rune
authors.initials: R
authors.lastname: Hedlund
authors.forename: James
authors.initials: J
authors.lastname: Harrop
authors.forename: Marcel
authors.initials: M
authors.lastname: Dvorak
authors.forename: Kirkham
authors.initials: K
authors.lastname: Wood
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.forename: Steven C
authors.initials: SC
authors.lastname: Zeiller
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Stock
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Brown
authors.forename: Timothy
authors.initials: T
authors.lastname: Kuklo
authors.forename: F C
authors.initials: FC
authors.lastname: Oner
mesh_terms: 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