Published Online:https://doi.org/10.1148/rg.337135018

Normal spine anatomy and the biomechanics of spine injuries are reviewed, imaging features of injury to the posterior ligamentous complex are described, and application of the Thoracolumbar Injury Classification and Severity Score is illustrated with three-dimensional modeling, animation, and case examples.

The Thoracolumbar Injury Classification and Severity Score (TLICS) is a scoring and classification system developed by the Spine Trauma Study Group in response to the recognition that previous classification systems have limited prognostic value and generally do not suggest treatment pathways. The TLICS provides a spine injury severity score based on three components: injury morphology, integrity of the posterior ligamentous complex (PLC), and neurologic status of the patient. A numerical score is calculated for each category, with a lower point value assigned to a less severe or less urgent injury and a higher point value assigned to a more severe injury requiring urgent management. The total score helps guide decision making about surgical versus nonsurgical management. The TLICS also emphasizes the importance of magnetic resonance imaging in evaluating PLC injury and acknowledges that the primary driver of surgical intervention is the patient’s neurologic status. Knowledge of PLC anatomy and its significance is essential in recognizing unstable injuries. Signs of PLC injury at computed tomography include interspinous distance widening, facet joint widening, spinous process fracture, and vertebral subluxation or dislocation. Familiarity with the TLICS will help radiologists who interpret spine trauma imaging studies to effectively communicate findings to spine trauma surgeons.The complete article is available online.

© RSNA, 2013

An earlier incorrect version of this article appeared online and in print. This article was corrected on April 30, 2020.

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Article History

Received: Mar 4 2013
Revision received: Apr 4 2013
Revision received: May 17 2013
Accepted: May 23 2013
Published online: Nov 2013
Published in print: Nov 2013