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World J Radiol. Sep 28, 2015; 7(9): 253-265
Published online Sep 28, 2015. doi: 10.4329/wjr.v7.i9.253
Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review
Shivanand Gamanagatti, Deepak Rathinam, Krithika Rangarajan, Atin Kumar, Kamran Farooque, Vijay Sharma
Shivanand Gamanagatti, Deepak Rathinam, Krithika Rangarajan, Atin Kumar, Department of Radiology, JPNA Trauma Center, AllIndia Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
Kamran Farooque, Vijay Sharma, Department of Orthopedics, JPNA Trauma Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
Author contributions: Gamanagatti S contributed to the conception, critical revision and image preparation; Rangarajan K helped with the article concept, revision literature search and image preparation; Rathinam D contributed towards article design, literature search, article drafting; Kumar A helped in images procurement, preparation and final approval of version of article to be published; Farooque K and Sharma V contributed in clinical perspective, revision of article and final approval.
Conflict-of-interest statement: The authors have nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Shivanand Gamanagatti, Additional Professor, Department of Radiology, JPNA Trauma Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. shiv223@gmail.com
Telephone: +91-11-26594889
Received: March 30, 2015
Peer-review started: March 31, 2015
First decision: April 27, 2015
Revised: May 14, 2015
Accepted: July 21, 2015
Article in press: July 23, 2015
Published online: September 28, 2015
Abstract

Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen (AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types (A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient’s neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score (TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.

Keywords: Trauma, Spine, Thoracolumbar, Classification, Management

Core tip: The thoracolumbar injury classification and severity score (TLICS) is the recent thoracolumbar injury grading scale to combine injury morphology, evaluation of mechanical strength pertinent to the posterior ligamentous complex, and neurologic condition into a method efficient of directing injury management. The TLICS provides the best available predictor of surgical vs nonsurgical management. Radiologists should use the key components of the TLICS to analyze, evaluate, and report spine injuries.