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, as determined by imaging, but also incorporates clinical features. 

Classification

The classification score is based on three major categories, known as parameters. There are two being radiologic categories and a third being a clinical assessment:

• 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: 

• compression

  • wedge compression fracture: 1 point 

  • burst fracture: 2 points

• translation/rotation: 3 points

• 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

• spinal cord or conus medullaris injury:

  • complete: 2 points

  • incomplete: 3 points

• cauda equina: 3 points

An important point to note is that an incomplete cord lesion will likely benefit from surgery more than a complete injury; a complete cord injury is scored as only 2 points whilst an incomplete cord injury is scored as 3 points ⁵.

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 points: usually treated non-operatively

• 4 points: may be treated operatively or non-operatively

• ≥ 5 points: usually considered for operative management