Validating a newly proposed classification system for thoracolumbar spine trauma: Looking to the future of the thoracolumbar injury classification and severity score

Background: Although numerous systems have been proposed, there is no universally accepted classification or scoring system for thoracolumbar spine injuries. Some have gained popularity, but most systems have never been modified or advanced beyond their initial introductory state. To the authors' knowledge, no thoracolumbar classification system has ever been validated in a systematic and scientific manner. Study Purpose: To critically review previous thoracolumbar classification systems, to discuss the proposal of the new Thoracolumbar Injury Classification and Severity Score (TLICS), to review the steps taken thus far in assessing the reliability of this system, and to discuss plans for future clinical validation of TLICS. Methods: The authors performed a comprehensive search and analysis of previously published systems for classifying or scoring thoracolumbar spine injuries. Based on the merits and faults of these systems, among other factors, they have developed TLICS. Conclusions: Of the three phases of validating a fracture classification system described by Audige et al, TLICS has successfully passed through phase I (development) and phase 2 (multicenter agreement studies). With modifications made in response to phase 2 studies, TLICS will be ready to enter into the clinical validation phase. Although TLICS will initially be assessed for its ability to predict type of treatment, it is the authors' hope that, with appropriate analysis, the system will also be predictive of injury severity and clinical outcomes. These qualities remain to be demonstrated through rigorous prospective clinical investigation.