thoracolumbar injury classification severity score .pptx

thoracolumbar injury classification severity score

1. SPINE INJURY- TLICS PG 3 orthopaedics UCMS & GTBH

2. Vaccaro, A.R. et al, Spine 2005

3. Spine Trauma Study Group :-- Thoracolumbar Injury Classification and Severity Score (TLICS) Injury Morphology Neurologic Status Integrity of PLC

4. Morphology of fracture

5. . Compression:-1

6. Burst:-2

7. Rotation/ Translation :-3

8. Distraction:-4

9. Fracture Dislocation :-4

10. Neurology-Point System Cauda equina Cord And conus medullaris Incomplete Complete Nerve root 3 3 2 2 Intact

11. Posterior ligament complex (PLC) PLC Intact 0 Injured 3 Suspected/Indeterminate 2

12. .Clinical features: Palpable gap b/w spinous process of lumbar spine Xray : Interspinous widening (indicates PLC compromise) These systems are applicable to all levels T1-L5

13. Next Step - Direct TX Assign Points Conservative Surgery

14. TLICS

15. Examples Flexion Compression Fx Flexion compression (morphology) - 1 Intact (neurology) - 0 PLC (ligament) no injury - 0 Total 1 points- Non Op

16. Compression Burst Fracture Flexion compression burst - 2 Intact ( neurology) - 0 PLC (ligament) no injury (0) Total 2 points-Non Op

17. Compression Burst-Complete Neuro Injury Axial compression burst with distraction posterior ligamentous complex -4 Complete (neurology) - 2 PLC (ligament) injury - 3 Total 9 points-Surgery

18. Compression Burst-Complete injury Axial compression burst-2 Complete (neurology)-2 PLC (ligament) Intact-0 Points 4-Non Op vs Op

19. Translational/Rotation Injury Distraction, Translation/rotational, compression injury - 4 Complete (neurology) – 2 PLC injury - 3 Total 9 points-Surgery

20. Question A 21 yr old female pt is struck by a bicycle. She has minimal back pain but is taken by ambulance to the hospital. On examination she had nuemerous abrasions and reports moderate discomfort on palpation of her spine There is a palpable gap between spinous processes in lumbar spine and clear interspinous widening between L2 and L3 on imaging She has difficulty in hip flexion on rt side. There is decreased sensation in a dermatomal distribution over anterior aspect of right thigh. What should be the best management for this pt.

21. Thank you