Thoracolumbar Injury Classification and Severity Scale (TLICS)

• Surgical decision-making is multifactorial and no single score should be used to make the decision to operate or not. Use in conjunction with clinical judgment.

• This system is designed to assist in stabilization.

• Decompression may also be needed with or without neurological deficit. Use best clinical judgment for decompression.

Recommendations:

• 0-3 points: Non-operative treatment (brace).

• Patients with neurological deficit may still need decompression but may be stable and not need instrumentation.

• 4 points: Non-operative or operative treatment (surgeon’s choice).

• A bracing trial can be conducted to verify stability with upright x-rays.

• Stabilization should be considered in patient with severe axial back pain once they become weight bearing.

• ≥5 points: Operative treatment (stabilize).

• Patient should be stabilized due to spinal instability from trauma.

• If appropriate, fracture reduction should be performed at the time of stabilization.

Bracing is typically performed by a variety of orthotic devices, such as:

• TLSO: T6-L5.

• Minerva: C1-T6.

• Jewett hyperextension brace: T5-T9.

Stabilization can be performed using:

• Posterior pedicle screw constructs.

• Anterior or lateral corpectomy with cage placement and vertebral body plating.

• Posterior lateral approaches to allow for corpectomy and expanding cage placement.

If a patient has a neurological deficit, it is strongly advised to carefully review films to help determine if decompression would be beneficial to the patient.