Thoracolumbar injury classification and severity score (TLICS)

The thoracolumbar injury classification and severity score (TLICS), also sometimes known as the thoracolumbar injury severity score (TISS), was developed by the Spine Trauma Group in 2005 to overcome some of the perceived difficulties regarding the use of other thoracolumbar spinal fracture classification systems for determining treatment 1. It is therefore not just a morphologic classification system but incorporates clinical features. 

Classification

Classification score is based on three major categories, known as parameters:

  • injury morphology
  • posterior ligamentous complex integrity
  • patient neurology

Points are assigned to parameters in each of the major categories.

Parameter
Morphology    

Morphology of the injury is divided into three patterns: 

  1. compression
  2. translation/rotation: 3 points
  3. distraction: 4 points
Posterior ligamentous complex
  • intact: 0 points
  • suspected injury or indeterminate: 2 points
  • injured: 3 points
Neurologic involvement
  • intact: 0 points
  • nerve root: 2 points
  • cord/conus medullaris (incomplete): 3 points
  • cord/conus medullaris (complete): 2 points
  • cauda equina: 3 points

Treatment and prognosis

The total number of points helps guide managing surgeons and physicians determine a management plan depending on the presence of other co-morbidities and injuries. Patient with a score of:

  • 1-3: usually treated non-operatively
  • 4: may be treated operatively or non-operatively
  • ≥5: usually considered for operative management
Fractures
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