Evaluation of the Thoracolumbar Injury Classification System (TLICS) in 458 Consecutively Treated Patients

Joao Paulo de Almeida, MD1, Andrei Joaquim, MD1, Enrico Ghizoni, MD1, Michel Daubs, MD1, Brandon Lawrence, MD1, Darrel Brodke, MD1, Fernando Cendes, MD, PhD1, Helder Tedeschi, MD, PhD1, Alpesh Patel, MD1

1Campinas, Brazil

Keywords: grading system, spinal cord injury, lumbar spine, trauma, thoracic spine

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       The Thoraco-Lumbar Injury Classification System (TLICS) system was developed to improve injury classification and guide surgical decision-making.
     Our purpose was to validate this scoring system.
     A retrospective analysis of 458 consecutive patients treated for thoracolumbar spine trauma from 2000 to 2010 at a single, tertiary medical center. 310 patients (67.6%) were treated conservatively (Group 1) and 148 patients (32.3%) were surgically (Group 2) treated. All patients in Group 1 were ASIA E, except one (ASIA C). In this group, 304 patients (98%) had an AO type A fracture.
     Clinical and radiological data were evaluated, classifying the injuries by ASIA status, the Magerl/AO classification, and the TLICS score.
     The TLICS score ranged from 1 to 7 (mean 1.53, median 1). 307/310 (99%) patients matched the TLICS treatment (TLICS = 4), except three with distractive injuries (TLICS 7) initially misclassified as burst fractures. Nine patients (2.9%) were converted to surgical management. In group 2, 105 (70.9%) were ASIA E while 43 (29%) had some neurological deficit (ASIA A-D). 103 patients (69.5%) were classified as AO type A, 36 (24.3%) as type B, and 9(6%) as type C. T. Sixty-nine patients (46.6%) matched the TLICS recommendations; all discordant patients (53.4%) were treated for stable burst fractures (TLICS=2).
     This is a retrospective study.
     The TLICS treatment recommendation matched successful treatment in 301/310 patients (97.1%) in the conservative group.
     However, in the surgical group, 53.4% of patients did not match TLICS recommendations, all were burst fractures without neurological injury (TLICS=2). This reflects continued inconsistencies in the treatment thoracolumbar burst fractures.


Project Roles:

J. de Almeida (), A. Joaquim (), E. Ghizoni (), M. Daubs (), B. Lawrence (), D. Brodke (), F. Cendes (), H. Tedeschi (), A. Patel ()