Abstract

A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury (or worsening of an already injured spine) if the fracture is "unstable", that is, likely to change alignment without internal or external fixation.

Risk of spinal cord injury

Vertebral fractures of the thoracic vertebrae, lumbar vertebrae or sacrum are usually associated with major trauma and can cause spinal cord injury that results in a neurological deficit.

Risk of spinal cord injury | Thoracolumbar injury classification and severity score

The thoracolumbar injury classification and severity score (TLICS) is a scoring system to determine the need to surgically treat a spinal fracture of thoracic or lumbar vertebrae. The score is the sum of three values, each being the score of the most fitting alternative in three categories:

Injury type

- Compression fracture - 1 point

- Burst fracture - 2 points

- Translational rotational injury - 3 points

- Distraction injury - 4 points

Posterior ligamentous complex

- Intact - 0 points

- Suspected injury or indeterminate - 2 points

- Injured - 3 points

Neurology

- Intact - 0 points

- Spinal nerve root injury - 2 points

- Incomplete injury of cord/conus medullaris - 3 points

- Complete injury of cord/conus medullaris (complete) - 2 points

- Cauda equina syndrome - 3 points

A TLICS score of less than 4 indicates non-operative treatment, a score of 4 indicates that the injury may be treated operatively or non-operatively, while a score of more than 4 means that the injury is usually considered for operative management.