# TLICS — Thoracolumbar Injury Classification and Severity score

> Per-patient thoracolumbar-trauma score using the highest morphology at the most severely involved level, posterior-ligamentous-complex integrity and the clinical neurologic examination. Totals of 3 or less, 4 and 5 or more are treatment-guidance bands rather than absolute orders or calibrated paralysis, mortality or deformity probabilities.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** Spine Trauma Study Group · **Versão:** Original 2005 TLICS; evidence and imaging-use boundaries reviewed through 2021 · **Ano:** 2005

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT, MRI
- Fonte primária: Vaccaro AR, Lehman RA, Hurlbert RJ, et al.. A new classification of thoracolumbar injuries (TLICS) (2005) — https://doi.org/10.1097/01.brs.0000182986.43345.cb
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Score the highest morphology at the most severely injured level, PLC status and a reliable clinical neurologic examination. Preserve component uncertainty, avoid multilevel summation and cervical modifiers, and treat the thresholds as guidance rather than prognosis or an autonomous order.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| <=3 | TLICS 3 or less, nonoperative candidate | TLICS total 3 or less. At the most severely involved thoracolumbar level, add only the highest morphology value (compression 1, burst 2, translation/rotation 3 or distraction 4), PLC status (intact 0, suspected/indeterminate 2 or injured 3) and the reliable clinical neurologic category (intact 0, nerve root 2, complete cord/conus 2, incomplete cord/conus 3 or cauda equina 3). Describe all injured levels but do not sum them. | The original algorithm supports nonoperative treatment as a candidate pathway, not an absolute command. Progressive neurologic deficit, open injury, deformity, ankylosing conditions, osteoporosis, polytrauma, soft tissues, comorbidity, patient goals and local expertise remain outside the total and can change care. | A lower total represents fewer points from disruptive morphology, PLC concern and neurologic injury within TLICS, but it is not a calibrated probability of stability, paralysis, deformity, nonunion, treatment failure or mortality. A low score cannot replace the actual examination and imaging findings. | Vaccaro et al., Spine 2005, DOI 10.1097/01.brs.0000182986.43345.cb, component and treatment tables; Lee et al., PMC2779435, score construction, thresholds and caveats; Jiménez-Almonte et al., PMC6263590, PLC limitations; WFNS 2021, PMC8752700, CT/MRI context. | ✓ |
| 4 | TLICS 4, operative or nonoperative candidate | TLICS total exactly 4, calculated from one highest morphology score at the most severely involved level plus PLC status and a clinical neurologic examination. If morphology, PLC or neurologic status is unresolved, preserve the component uncertainty and conditional score range rather than forcing exactly 4. | Either operative or nonoperative treatment may be appropriate; the original framework explicitly leaves this band to clinical judgment. Make the decisive morphology, PLC certainty, neurologic state, patient modifiers and competing injuries visible instead of relabeling 4 as automatically stable or unstable. | The intermediate decision band is not a validated risk percentage. Multiple clinically different component combinations yield 4, so the number alone does not predict neurologic recovery, late kyphosis, treatment failure, reoperation or mortality. | Vaccaro et al., Spine 2005, DOI 10.1097/01.brs.0000182986.43345.cb, treatment recommendation table; Lee et al., DOI 10.1007/s00776-005-0956-y, operative versus nonoperative discretion and caveats; Magnusson et al., PMC5919222, description and limitations. | ✓ |
| >=5 | TLICS 5 or more, operative candidate | TLICS total 5 or more, calculated from the single highest morphology at the most severely involved level, PLC status and the clinical neurologic examination. Do not add multiple morphology patterns, multiple levels or the SLIC ongoing-cord-compression modifier. | The original algorithm supports operative treatment as a candidate pathway, but the total does not choose timing, approach, decompression, levels or instrumentation and is not absolute. Integrate neurologic urgency, mechanical findings, polytrauma, soft tissues, comorbidity and patient-specific constraints. | A higher total reflects more points from structural disruption, PLC injury and/or neurologic deficit, not a patient-specific probability of paralysis, mortality or late deformity. The exact components carry more clinical meaning than the band alone. | Vaccaro et al., Spine 2005, DOI 10.1097/01.brs.0000182986.43345.cb, scoring and operative-candidate threshold; Lee et al., PMC2779435, components and caveats; Jiménez-Almonte et al., PMC6263590, reliability limitations; WFNS 2021, PMC8752700, contemporary imaging context. | ✓ |

### Citações por categoria
- **<=3**: Vaccaro AR, Lehman RA, Hurlbert RJ, et al.. A new classification of thoracolumbar injuries (TLICS) (2005) — https://doi.org/10.1097/01.brs.0000182986.43345.cb · Vaccaro et al., Spine 2005, DOI 10.1097/01.brs.0000182986.43345.cb, component and treatment tables; Lee et al., PMC2779435, score construction, thresholds and caveats; Jiménez-Almonte et al., PMC6263590, PLC limitations; WFNS 2021, PMC8752700, CT/MRI context.
- **4**: Vaccaro AR, Lehman RA, Hurlbert RJ, et al.. A new classification of thoracolumbar injuries (TLICS) (2005) — https://doi.org/10.1097/01.brs.0000182986.43345.cb · Vaccaro et al., Spine 2005, DOI 10.1097/01.brs.0000182986.43345.cb, treatment recommendation table; Lee et al., DOI 10.1007/s00776-005-0956-y, operative versus nonoperative discretion and caveats; Magnusson et al., PMC5919222, description and limitations.
- **>=5**: Vaccaro AR, Lehman RA, Hurlbert RJ, et al.. A new classification of thoracolumbar injuries (TLICS) (2005) — https://doi.org/10.1097/01.brs.0000182986.43345.cb · Vaccaro et al., Spine 2005, DOI 10.1097/01.brs.0000182986.43345.cb, scoring and operative-candidate threshold; Lee et al., PMC2779435, components and caveats; Jiménez-Almonte et al., PMC6263590, reliability limitations; WFNS 2021, PMC8752700, contemporary imaging context.

## Referências cruzadas
- _fronteira compartilhada_ → [AO Spine TL — AO Spine thoracolumbar injury classification and TL AOSIS](https://radcommons.laudos.ai/systems/aospine-tl.md) — TLICS uses its own morphology, PLC and neurologic point table with 3/4/5 thresholds. AO Spine assigns an exact A0-A4, B1-B3 or C morphology plus N and M codes and a separate TL AOSIS total; no category or total crosswalk is valid.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2021-12-01 | revised | WFNS recommendations retained TLICS and AO Spine as valid thoracolumbar-trauma frameworks and supplied CT/MRI context; they did not create a new TLICS version or make its thresholds absolute. | confirmed |
| 2005-10-15 | published | The Spine Trauma Study Group published the original TLICS components, scores and treatment-guidance thresholds. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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