Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety

Study Design Systematic literature review. Objective The Thoracolumbar Injury Classification and Severity Score System (TLICS) is widely used to help guide the treatment of thoracolumbar spine trauma. The purpose of this study is to evaluate the safety of the TLICS in clinical practice. Methods Using the Medline database without time restriction, we performed a systematic review using the keyword Thoracolumbar Injury Classification, searching for articles utilizing the TLICS. We classified the results according to their level of evidence and main conclusions. Results Nine articles met our inclusion and exclusion criteria. One article evaluated the safety of the TLICS based on its clinical application (level II). The eight remaining articles were based on retrospective application of the score, comparing the proposed treatment suggested by the TLICS with the treatment patients actually received (level III). The TLICS was safe in surgical and nonsurgical treatment with regards to neurologic status. Some studies reported that the retrospective application of the TLICS had inconsistencies with the treatment of burst fractures without neurologic deficits. Conclusions This literature review suggested that the TLICS use was safe especially with regards to preservation or improvement of neurologic function. Further well-designed multicenter prospective studies of the TLICS application in the decision making process would improve the evidence of its safety. Special attention to the TLICS application in the treatment of stable burst fractures is necessary.