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Thoracolumbar fractures and the TLICS score
In a thoracolumbar fracture the decision to operate rests on the TLICS score — fracture morphology, integrity of the posterior ligamentous complex and neurological status — and a burst fracture in a patient with no deficit and an intact posterior complex is usually treated without surgery.
Why it matters in the exam
The TLICS score: morphology — compression 1, burst 2, translation or rotation 3, distraction 4; posterior ligamentous complex (PLC) — intact 0, suspected 2, disrupted 3; neurology — intact 0, root 2, complete cord injury 2, incomplete cord or cauda equina injury 3. A score of 3 or less — non-operative with early mobilisation; 4 — either, by patient and surgeon; 5 or more — surgery. The logic: an incomplete injury is "worth" more points than a complete one, because there is something to save by decompression. The exam also uses the AO Spine description: type A — compression, type B — failure of the tension band (posterior or anterior), and type C — translation in any direction.
A Chance fracture comes from flexion-distraction around a lap belt, passes through bone or ligaments of all three columns, and in about half of cases is accompanied by an intra-abdominal injury — so a bowel injury must be sought. A burst fracture with retropulsion into the canal and an incomplete deficit needs decompression and fixation. In the lower vertebrae the spinal cord ends at L1 to L2: injury at T12 to L1 can damage the conus (symmetric deficit, early sphincter involvement), and below L2 the injury is to the cauda equina roots (asymmetric deficit, radicular pain). The kyphotic angle is measured by the Cobb method between the upper endplate of the vertebra above the fracture and the lower endplate of the vertebra below it. In a patient with one spinal fracture a second non-contiguous fracture is sought, present in about 10% of cases.
Key points
- TLICS: morphology, PLC, neurology.
- 3 or less non-operative; 5 or more surgery.
- Burst fracture with no deficit and an intact PLC — non-operative.
- Chance — lap belt, bowel injury in about half.
- CT of the whole spine — second fracture in about 10%.
Summary table
| TLICS component | Option | Points |
|---|---|---|
| Morphology | Compression / burst / translation or rotation / distraction | 1 / 2 / 3 / 4 |
| Posterior ligamentous complex | Intact / suspected / disrupted | 0 / 2 / 3 |
| Neurology | Intact / root or complete injury / incomplete or cauda equina | 0 / 2 / 3 |
| Decision | 3 or less non-operative; 4 either; 5 or more surgery | Sum |
A free exam question
מה מתאר נכון את קלאסיפיקציית TLICS לטראומה של עמוד השדרה הגבי- מותני? (the question as examined, in Hebrew)
- א. שבר BURST מקבל דירוג מקסימאלי בקטגוריית מורפולוגיה
- ב. הערכה של הליגמנטים האחוריים בקטגוריית Posterior Ligamentous Complex מתבצעת לפי MRI
- ג. חסר נוירולוגי מלא מקבל ציון מקסימאלי בקטגוריית הסטאטוס הנוירולוגי
- ד. סכום נקודות של 3 ומעלה מועמד לניתוח קיבוע
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Sources
- Thoracolumbar Injury Classification and Severity Score (TLICS), 2005 — Scoring and treatment thresholds
- AO Spine Thoracolumbar Spine Injury Classification System, 2013 — Types A, B and C
- American College of Surgeons ATLS, 10th edition (2018) — Spine and spinal cord trauma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.