title: Evaluation of a new spine classification system, does it accurately predict treatment?
abstract: METHODS
  The Thoracolumbar Injury Severity Score (TLISS) was introduced as a novel classifications system. Its aim was to simplify classification of thoracolumbar fractures, grade their severity in an ordinal manner as a guide to management. This study attempted to validate the TLISS as a guide to management.
  
  
  OBJECTIVE
  To evaluate the TLISS as a tool for guiding management of thoracolumbar fractures using the outcomes of 97 previously treated spinal fracture.
  
  
  BACKGROUND
  The TLISS was proposed as a tool for guidance of the management of thoracolumbar fractures to aid the surgeon in choosing management.
  
  
  METHODS
  Ninety-seven sequential traumatic thoracolumbar fractures were retrospectively reviewed for their management and outcomes. The presenting clinical information had all personal identifiers removed and the fractures were reevaluated by the treating physician using the TLISS. Eighty-one patients had received management that agreed with the suggested management of the TLISS. Nine patients had a score of 4. Seven patients received management that disagreed with the TLISS. Variables affecting the management that differed from the management suggested by the TLISS were identified in each patient and assessed.
  
  
  RESULTS
  Of the 97 patients identified, 81 had received management that agreed with the suggested management of the TLISS. Of the 16 remaining patients, 3 patients scored a 3 or less and received an operation, 1 of which, failed conservative management. Four scored a 5 or more and were managed conservatively, none with known failure. Nine patients scored the ambiguous score of 4. Of these, 4 were managed operatively and 5 nonoperatively.
  
  
  CONCLUSIONS
  As a management tool, the TLISS seems to consistently suggest treatment consistent with past treatment recommendations. Multilevel contiguous fractures and extension injuries in the ankylosed thoracic spine appear to be the most consistent exceptions to the TLISS guidelines.
authors.affiliation: Saint Louis University Hospital, Saint Louis, MO, USA. lenarzcj@slu.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lenarz
authors.forename: Howard M
authors.initials: HM
authors.lastname: Place
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000145:classification; D011859:Radiography; D016103:Spinal Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000628:therapy; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D016896:Treatment Outcome