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A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. Most types of spinal fracture confer a significant risk of spinal cord injury. After the immediate trauma, there is a risk of spinal cord injury (or worsening of an already injured spine) if the fracture is unstable, that is, likely to change alignment without internal or external fixation.[1]

Spinal fracture
SynonymsVertebral fracture, broken back
L1 2 vertebral fracture.jpg
Lateral spine X-ray showing osteoporotic wedge fractures of L1/2
CASH Orthosis.



Risk of spinal cord injuryEdit

Vertebral fractures of the thoracic vertebrae, lumbar vertebrae or sacrum are usually associated with major trauma and can cause spinal cord injury that results in a neurological deficit.[4]

Thoracolumbar injury classification and severity scoreEdit

The thoracolumbar injury classification and severity score (TLICS) is a scoring system to determine the need to surgically treat a spinal fracture of thoracic or lumbar vertebrae. The score is the sum of three values, each being the score of the most fitting alternative in three categories:[5]

Injury type

  • Compression fracture - 1 point
  • Burst fracture - 2 points
  • Translational rotational injury - 3 points
  • Distraction injury - 4 points

Posterior ligamentous complex

  • Intact - 0 points
  • Suspected injury or indeterminate - 2 points
  • Injured - 3 points


A TLICS score of less than 4 indicates non-operative treatment, a score of 4 indicates that the injury may be treated operatively or non-operatively, while a score of more than 4 means that the injury is usually considered for operative management.[5]

AOSpine Thoracolumbar Injury Classification SystemEdit

AOSpine Thoracolumbar Injury Classification System (ATLICS)[6] is the most recent classification scheme for thoracolumbar injuries.[7] ATLICS is broadly based on the TLICS system and has sufficient reliability irrespective of the experience of the observer.[7] ATLICS is primarily focused on fracture morphology, and has two additional sections addressing the neurological grading and clinical modifiers:[6]

Fracture morphologyEdit

  • Type A: Compression injuries (sub-types A0-A4)
  • Type B: Distraction injuries (sub-types B1-B3)
  • Type C: Translation injuries

Neurological statusEdit

  • N0: neurologically intact
  • N1: transient deficit
  • N2: radiculopathy
  • N3: "incomplete spinal cord injury or cauda equina injury"[6]
  • N4: "complete spinal cord injury"[6]
  • NX: unknown neurological status


  • M1: unknown tension band injury status
  • M2: comorbidities


  1. ^ "Fracture". MDguidelines by the American Medical Association. Retrieved 2017-10-26.
  2. ^ Augustine, J.J. (21 November 2011). "Spinal trauma". In Campbell, J.R. International Trauma Life Support for Emergency Care Providers. Pearson Education. ISBN 978-0-13-300408-3.
  3. ^ a b Clark West, Stefan Roosendaal, Joost Bot and Frank Smithuis. "Spine injury - TLICS Classification". Radiology Assistant. Retrieved 2017-10-26.
  4. ^ Mirghasemi, Alireza; Mohamadi, Amin; Ara, Ali Majles; Gabaran, Narges Rahimi; Sadat, Mir Mostafa (November 2009). "Completely displaced S-1/S-2 growth plate fracture in an adolescent: case report and review of literature". Journal of Orthopaedic Trauma. 23 (10): 734–738. doi:10.1097/BOT.0b013e3181a23d8b. ISSN 1531-2291. PMID 19858983.
  5. ^ a b Buck Christensen. "Thoracolumbar Injury Classification and Severity (TLICS) Scale". Medscape. Retrieved 2017-10-26. Updated: Dec 09, 2014
  6. ^ a b c d Vaccaro, Alexander R.; Oner, Cumhur; Kepler, Christopher K.; Dvorak, Marcel; Schnake, Klaus; Bellabarba, Carlo; Reinhold, Max; Aarabi, Bizhan; Kandziora, Frank (November 2013). "AOSpine Thoracolumbar Spine Injury Classification System". Spine. 38 (23): 2028–2037. doi:10.1097/brs.0b013e3182a8a381. ISSN 0362-2436.
  7. ^ a b Abedi, Aidin; Mokkink, Lidwine B; Zadegan, Shayan A; Paholpak, Permsak; Tamai, Koji; Wang, Jeffrey C; Buser, Zorica (October 2018). "Reliability and Validity of the AOSpine Thoracolumbar Injury Classification System: A Systematic Review." Global Spine Journal. 2192568218806847. doi:10.1177/2192568218806847.

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