Vaccaro Alexander R, Lehman Ronald A, Hurlbert R John, Anderson Paul A, Harris Mitchel, Hedlund Rune, Harrop James, Dvorak Marcel, Wood Kirkham, Fehlings Michael G, Fisher Charles, Zeiller Steven C, Anderson D Greg, Bono Christopher M, Stock Gordon H, Brown Andrew K, Kuklo Timothy, Oner F C
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Spine (Phila Pa 1976). 2005 Oct 15;30(20):2325-33. doi: 10.1097/01.brs.0000182986.43345.cb.
A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management.
To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care and surgical treatment approach in unstable injury patterns.
The most appropriate classification of traumatic TL spine injuries remains controversial. Systems currently in use can be cumbersome and difficult to apply. None of the published classification schemata is constructed to aid with decisions in clinical management.
Clinical spine trauma specialists from a variety of institutions around the world were canvassed with respect to information they deemed pivotal in the communication of TL spine trauma and the clinical decision-making process. Traditional injury patterns were reviewed and reconsidered in light of these essential characteristics. An initial validation process to determine the reliability and validity of an earlier version of this system was also undertaken.
A new classification system called the Thoracolumbar Injury Classification and Severity Score (TLICS) was devised based on three injury characteristics: 1) morphology of injury determined by radiographic appearance, 2) integrity of the posterior ligamentous complex, and 3) neurologic status of the patient. A composite injury severity score was calculated from these characteristics stratifying patients into surgical and nonsurgical treatment groups. Finally, a methodology was developed to determine the optimum operative approach for surgical injury patterns.
Although there will always be limitations to any cataloging system, the TLICS reflects accepted features cited in the literature important in predicting spinal stability, future deformity, and progressive neurologic compromise. This classification system is intended to be easy to apply and to facilitate clinical decision-making as a practical alternative to cumbersome classification systems already in use. The TLICS may improve communication between spine trauma physicians and the education of residents and fellows. Further studies are underway to determine the reliability and validity of this tool.
一种新提出的胸腰椎（TL）脊柱损伤分类系统，包括损伤严重程度评估，旨在辅助临床管理。
设计一种实用且全面的TL损伤分类系统，以协助就不稳定损伤模式下手术治疗与非手术治疗的需求以及手术治疗方法进行临床决策。
创伤性TL脊柱损伤的最合适分类仍存在争议。目前使用的系统可能繁琐且难以应用。已发表的分类方案均未构建用于辅助临床管理决策。
就他们认为在TL脊柱创伤沟通和临床决策过程中至关重要的信息，向世界各地各种机构的临床脊柱创伤专家进行了调查。根据这些基本特征对传统损伤模式进行了回顾和重新考量。还进行了初步验证过程，以确定该系统早期版本的可靠性和有效性。
基于三种损伤特征设计了一种名为胸腰椎损伤分类与严重程度评分（TLICS）的新分类系统：1）由影像学表现确定的损伤形态，2）后韧带复合体的完整性，3）患者的神经状态。根据这些特征计算综合损伤严重程度评分，将患者分为手术和非手术治疗组。最后，开发了一种方法来确定手术损伤模式的最佳手术方法。
尽管任何编目系统总会有局限性，但TLICS反映了文献中提及的在预测脊柱稳定性、未来畸形和进行性神经功能损害方面重要的公认特征。该分类系统旨在易于应用，并作为现有繁琐分类系统的实用替代方案促进临床决策。TLICS可能会改善脊柱创伤医生之间的沟通以及住院医师和研究员的教育。正在进行进一步研究以确定该工具的可靠性和有效性。
