Vaccaro et al. introduce the Thoracolumbar Injury Classification and Severity Score (TLICS), created by 40 international spine trauma experts. The system answers two questions every time: operate or not, and from which direction? It scores three variables — fracture morphology, PLC integrity, and neurologic status — into a single actionable number.
Walk through the three TLICS questions every time you see a thoracolumbar fracture: How destructive is the pattern? Is the posterior tension band intact? Is there a neurologic deficit, and is it complete or incomplete?
A neurologically intact burst fracture with an intact PLC scores 2 — treat nonoperatively. Add an incomplete cord injury and the score jumps to 5, mandating surgery with an anterior approach to address anterior cord compression. Add PLC disruption to that incomplete injury and the score reaches 8, requiring a combined approach.
The PLC component is the most practice-changing element: a disrupted posterior tension band adds 3 points and shifts the approach to posterior regardless of fracture morphology. Every prior system. Denis and AO included. Described injuries without prescribing treatment.
TLICS was later refined into the AO Spine Thoracolumbar Injury Classification System (2013), but its three-variable framework remains the conceptual foundation of modern thoracolumbar fracture management.
Vaccaro et al. introduce the Thoracolumbar Injury Classification and Severity Score (TLICS), created by 40 international spine trauma experts. The system answers two questions every time: operate or not, and from which direction? It scores three variables — fracture morphology, PLC integrity, and neurologic status — into a single actionable number.
Walk through the three TLICS questions every time you see a thoracolumbar fracture: How destructive is the pattern? Is the posterior tension band intact? Is there a neurologic deficit, and is it complete or incomplete?
A neurologically intact burst fracture with an intact PLC scores 2 — treat nonoperatively. Add an incomplete cord injury and the score jumps to 5, mandating surgery with an anterior approach to address anterior cord compression. Add PLC disruption to that incomplete injury and the score reaches 8, requiring a combined approach.
The PLC component is the most practice-changing element: a disrupted posterior tension band adds 3 points and shifts the approach to posterior regardless of fracture morphology. Every prior system. Denis and AO included. Described injuries without prescribing treatment.
TLICS was later refined into the AO Spine Thoracolumbar Injury Classification System (2013), but its three-variable framework remains the conceptual foundation of modern thoracolumbar fracture management.