Spinal fracture

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

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]


Risk of spinal cord injury[edit]

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 score[edit]

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]


  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

External links[edit]

External resources