Openai/69525f34-c274-8008-8a68-a50fa8d68cd8

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User: Thoracolumbar Injury Classification and

Thoracolumbar Injury Classification and Severity

Assistant: Thoracolumbar Injury Classification and Severity Score TLICS

Thoracolumbar Injury Classification and Severity Score (TLICS)

!https://radiologyassistant\.nl/assets/spine\-injury\-tlics\-classification/a54c216784651b\_9j\-TAB\-overview\.png !https://www\.researchgate\.net/publication/379535527/figure/fig4/AS%3A11431281283975881%401729043687442/MRI\-findings\-of\-complete\-posterior\-ligamentous\-complex\-injury\-A\-B\-complete\-PLC\.jpg !https://prod\-images\-static\.radiopaedia\.org/images/18979/72c9b4c7b122501e57f63da52f0e1e\_gallery\.jpeg 4 نظام TLICS هو النظام الأهم والأكثر اعتمادًا حاليًا لتقييم Thoracolumbar spine trauma، لأنه لا يكتفي بالوصف التشريحي، بل يربط التصنيف مباشرة بقرار العلاج. يعتمد على 3 محاور أساسية، وكل محور له Score، والمجموع النهائي يوجّه القرار العلاجي.

1️⃣ Injury Morphology (شكل الإصابة)

يُحدَّد أساسًا من CT scan، وأحيانًا MRI.

▪ Compression injury – Score 1

• Loss of anterior vertebral body height
• Stable غالبًا
• Examples: simple wedge fracture

▪ Burst fracture – Score 2

• Posterior wall involvement
• Risk of canal compromise
• Stability depends on PLC

▪ Translation / Rotation injury – Score 3

• Horizontal displacement أو rotation
• Highly unstable
• Indicates severe ligamentous disruption

▪ Distraction injury – Score 4

• Failure under tension
• Seen in flexion-distraction injuries (Chance fracture)

📌 Exam pearl: Translation/rotation أخطر من burst، وdistraction أخطرهم جميعًا من ناحية instability.

2️⃣ Posterior Ligamentous Complex (PLC)

يتكوّن من:

• Supraspinous ligament
• Interspinous ligament
• Ligamentum flavum
• Facet joint capsules

يُقيَّم أساسًا بـ MRI.

▪ Intact – Score 0

• No edema, normal alignment

▪ Indeterminate / suspected – Score 2

• Subtle edema
• Equivocal MRI findings

▪ Disrupted – Score 3

• Clear discontinuity
• Widened interspinous distance
• Facet dislocation

📌 High-yield جدًا: PLC injury = game changer → غالبًا surgery حتى لو fracture شكله بسيط.

3️⃣ Neurological Status

▪ Complete spinal cord injury – Score 2

• Surgery لا تحسّن neurological outcome
• لكن قد تُجرى لأسباب stability/pain

▪ Incomplete spinal cord injury – Score 3

• Strong indication for surgery

▪ Cauda equina syndrome – Score 3

• Surgical emergency

📌 Exam pearl: Incomplete cord injury أخطر من complete من حيث decision making → surgery indicated.

📊 Total TLICS Score & Treatment Decision

🔹 Score ≤ 3

➡️ Non-operative treatment

• Brace
• Mobilization
• Close follow-up

🔹 Score = 4

➡️ Gray zone

• Surgeon judgment
• Patient factors
• Radiology details

🔹 Score ≥ 5

➡️ Operative management

• Posterior instrumentation ± decompression
• Sometimes anterior reconstruction

Clinical مثال سريع (امتحاني):

• Burst fracture (2)
• PLC disrupted (3)
• Neurologically intact (0)

👉 Total = 5 → Surgery

Why TLICS مهم جدًا في الامتحانات؟

• Decision-based system
• Easy MCQs
• Frequently asked in: - FRCS - Arab Board - Orthopaedic trauma exams

References (High-yield):

• Orthobullets – Thoracolumbar Spine Trauma
• AAOS Spine Trauma Guidelines
• Vaccaro et al., Spine, TLICS original description

لو حابب:

• أعمل MCQs مباشرة على TLICS
• أو Cases with CT/MRI and scoring step-by-step
• أو مقارنة سريعة بين TLICS vs AO Spine Classification

قولّي وتابع معايا، يا محمد 👌