The information below is contained in papers found in the literature search carried out to inform this clinical decision making tool.

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Thoraco-Lumbar Injury Classification and Severity score (TLICS)

The Thoraco-Lumbar Injury Classification and Severity score (TLICS) is a classification system for thoracolumbar spine injuries, designed to assist in clinical management.

Unlike other classifications, the TLICS is an easy scoring system that depicts the features important in predicting spinal stability, future deformity, and progressive neurologic compromise. TLICS also facilitates appropriate treatment recommendations.

Clark West, Stefan Roosendaal, Joost Bot and Frank Smithuis.  TLICS Classification of fractures: Thoraco-Lumbar Injury Classification and Severity score. 2015

The information below is contained in papers found in the literature search carried out to inform this clinical decision making tool. The evidence is regularly updated.

The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis and presently CT is mandatory for an accurate classification.

Columns

Denis divided the vertebral column into 3 vertical parallel columns based on biomechanical studies related to stability following traumatic injury. Instability occurs when injuries affect 2 contiguous columns (i.e. anterior and middle column or middle and posterior column). Obviously a 3 column injury is unstable. The three columns are:

Anterior column

• anterior longitudinal ligament (ALL)
• anterior two-thirds of the vertebral body
• anterior two-thirds of the intervertebral disc (annulus fibrosus)

Middle column

• posterior one-third of the vertebral body
• posterior one-third of the intervertebral disc (annulus fibrosus)
• posterior longitudinal ligament (PLL)

Posterior column

• Everything posterior to the PLL
• pedicles
• facet joints and articular processes
• ligamentum flavum
• neural arch and interconnecting ligaments

Guidelines

National Institute for Health and Care Excellence (NICE). Spinal injury: assessment and initial management. 2016.