Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma

Retrospective study.

Evaluate the relationship among the neurologic status, the Thoracolumbar Injury Classification System (TLICS) score, and the Magerl/AO classification system.

A wide range of classification schemes for thoracic and lumbar spine trauma have been described, but none has achieved widespread acceptance. A recent system proposed by Vaccaro et al has been developed to improve injury classification and guide surgical decision making.

Analysis of 49 patients treated surgically for thoracic and lumbar spine trauma from 2003 to 2009 in 2 spine trauma centers. Clinical and radiologic data were evaluated, classifying the trauma according to American Spinal Injury Association status, the Magerl/AO classification for fractures, and the TLICS score.

The mean age was 37 years (range, 17-72). Thirty-five (71%) patients had a thoracolumbar fracture (T11-L2). A posterior approach was used in all the cases. American Spinal Injury Association status remained unchanged in 44 (4 had some improvement and 1 worsened). A total of 61.1% of the patients with a type A fracture were neurologically intact compared with 80% with complete neurologic deficit for type C fractures. The TLICS score range from 2 to 9 (average of 6.2). Forty-seven of 49 (96%) patients had a TLICS score greater than 4, suggesting surgical treatment. Seventy percentage of the patients with a TLICS score from 4 to 6 were neurologically intact compared with 87.5% of complete neurologic deficits in patients with TLICS 7 to 9. A statistic correlation was established between the neurologic status and AO type fracture (P = 0.0041) and the TLICS score (P < 0.0001). An association between the AO type fracture and the TLICS score was also found (P = 0.0088).

The TLICS score treatment recommendation matched surgical treatment in 47 of 49 patients (96%). The TLICS was found to correlate to the AO classification. This suggests that the TLICS can be used to classify thoracolumbar trauma and can accurately predict surgical management.