Thoracolumbar Injury Classification and Severity Scale (TLICS)

TLICS Calculator

Injury Morphology

Posterior Ligamentous Complex (PLC) Integrity

Neurological Status

TLICS Score: –

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Classifies thoracolumbar spine injury and provides treatment recommendations.

Why Use

Intuitive, evidence-based method for determining spinal instability.

When to Use

Patients with thoracolumbar fracture involving vertebral body, pars, or pedicle, and any significant ligamentous injury.

Formula

Addition of the selected points: Variable Points Morphology Compression fracture 1 Burst fracture 2 Translational/rotational 3 Distraction 4 None of the above 0 Neurologic involvement Intact 0 Nerve root 2 Complete cord 2 Incomplete cord 3 Cauda equina 3 Posterior ligamentous complex Intact 0 Injury suspected or indeterminate 2 Injured 3

Pearls / Pitfalls

Make sure to have appropriate imaging to evaluate the posterior column. On CT, look for widened facet joints and interspinous spaces. If posterior columns are not visualized on CT, then MRI is required. If a patient has a neurological deficit, it is strongly advised to carefully review films to help determine if decompression would be beneficial to the patient. Consider patient’s comorbidities and other underlying pathologies that may have predisposed the patient to injury, e.g. osteopenia/osteoporosis, infection, malignancy.

Management

Recommendations: 0-3 points: Non-operative treatment (brace). Patients with neurological deficit may still need decompression but may be stable and not need instrumentation. 4 points: Non-operative or operative treatment (surgeon’s choice). A bracing trial can be conducted to verify stability with upright x-rays. Stabilization should be considered in patient with severe axial back pain once they become weight bearing. ≥5 points: Operative treatment (stabilize). Patient should be stabilized due to spinal instability from trauma. If appropriate, fracture reduction should be performed at the time of stabilization. Bracing is typically performed by a variety of orthotic devices, such as: TLSO: T6-L5. Minerva: C1-T6. Jewett hyperextension brace: T5-T9. Stabilization can be performed using: Posterior pedicle screw constructs. Anterior or lateral corpectomy with cage placement and vertebral body plating. Posterior lateral approaches to allow for corpectomy and expanding cage placement.

Critical Actions

If a patient has a neurological deficit, it is strongly advised to carefully review films to help determine if decompression would be beneficial to the patient.

Advice

Surgical decision-making is multifactorial and no single score should be used to make the decision to operate or not. Use in conjunction with clinical judgment. This system is designed to assist in stabilization. Decompression may also be needed with or without neurological deficit. Use best clinical judgment for decompression.

More Information

Interpretation: TLICS Management 0-3 points Non-operative (recommend bracing) 4 points Non-operative or operative ≥5 points Operative (stabilization with or without fracture reduction as appropriate)