Imaging evaluation of traumatic thoracolumbar spine injuries: Radiological review

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.

Emergency and Trauma Imaging of the Thoracolumbar Spine

“…According to the Denis system, burst fractures are unstable injuries that may require surgical stabilization. 1,50,51 Subsequent modifications of the Denis classification have recognized that with an intact PLC, twocolumn unstable injuries can be treated nonsurgically. This has created a confusing category of burst fractures referred to as "unstable stable" fractures.…”

“…The AO system emphasizes the importance of injuries to soft tissue structures such as the PLC, intervertebral disks, and ALL with respect to spine instability. 1,9 Although the Magerl/AO classification provided a comprehensive morphological description of fracture subtypes, the system was criticized for its high complexity, its low reliability, and its lack of incorporation of neurologic status. 1,9,53,55 In 2005, the TLICS, a new system, was proposed by the STSG as a tool to help surgeons to treat thoracic and lumbar spine fractures.…”

Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates

“…Spinal injuries after major trauma are common, and thoracic and lumbar regions account for 75% to 90% of spinal fractures. [ 1 , 2 ] Treatment strategies are guided by radiological parameters that indicate instability and deformity, and pain is related to vertebral height loss and increased kyphosis. [ 1 , 3 , 4 ]…”

Role of Thoracolumbar Injury Classification and Severity Score (Tlics) System in Diagnostic and Prognostic Evaluation of Thoracolumbar Spinal Trauma Using Ct and Mri

“…The classification system is based on three major categories: the morphology of the injury; the integrity of the posterior ligamentous complex (PLC); and the neurologic status of the patient. (12) TLICS is supposed to facilitate appropriate treatment recommendations.…”