The Integrated Nerve, Discoligamentous Complex, and Vertebra Scoring System for Thoracolumbar Junction (TLJ) Injury

To avoid the confusion of mechanism, tissue, morphology, and injury severity that resulted from previous modified AO, the Thoracolumbar Injury Classification and Severity Score (TLICS), the Thoracolumbar AO Spine Injury Score (TL AOSIS), and Load Sharing Classification (LSC), the integrated scoring system is devised for thoracolumbar junction (TLJ) injury that can better assist clinical decision-making strategy.

We reviewed the literature of TLJ classification and TLICS 4-point treatment. Scoring and remedy strategies were proposed retrospectively. Patients included were validated with the change of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) after surgical treatment retrospectively. The interobserver and intraobserver reliability was also evaluated.

Nerve, discoligamentous complex (DLC), and vertebral bone that are three main spinal structures are weighted as 5, 4, and 3 points, respectively. If nerve injury ≥ 3 and/or bone + DLC injury ≥ 4, surgical treatment is recommended. If nerve injury = 2, delayed surgery may be needed after close observation of consistent pain. If nerve injury ≤ 1 or the bone + DLC score < 4, conservative treatment is recommended. When LSC ≥ 7, it may require vertebrectomy and anterior/middle column instrumentation. In ADLC = 2 of LSC ≤ 6, the removal of the injured disc and interbody fusion is needed, or only posterior fixation without intervertebral fusion. The consistency of the integrated system indicated substantial reliability.

This system showed substantial reliability and a desirable prognosis in TLJ patients. It could help differentiate injury morphology from severity and prevent the assignment of undue values to certain components, thereby providing a practicable decision-making strategy for TLJ injured patients.