J Korean Neurosurg Soc.  2015 Mar;57(3):174-177. 10.3340/jkns.2015.57.3.174.

Applicability of Thoracolumbar Injury Classification and Severity Score to Criteria of Korean Health Insurance Review and Assessment Service in Treatment Decision of Thoracolumbar Injury

  • 1Department of Neurosurgery and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. farlateral@hanmail.net


For improving the drawbacks of previous thoracolumbar spine trauma classification, the Spine Trauma Study Group was developed new classification, Thoracolumbar Injury Classification and Severity Score (TLICS). The simplicity of this scoring system makes it useful clinical application. However, considering criteria of Korean Health Insurance Review and Assessment Service (HIRA), the usefulness of TLICS system is still controversial in the treatment decision of thoracolumbar spine injury.
Total 100 patients, who admitted to our hospital due to acute traumatic thoracolumbar injury, were enrolled. In 45, surgical treatment was performed and surgical treatment was decided following the criteria of HIRA in all patients. With assessing of TLICS score and Denis's classification, the treatment guidelines of TLICS and Denis's classification were applied to the criteria of Korean HIRA.
According to the Denis's three-column spine system, numbers of patients with 2 or 3 column injuries were 94. Only 45 of 94 patients (47.9%) with middle column injury fulfilled the criteria of HIRA. According to TLICS system, operation required fractures (score>4) were 31 and all patients except one fulfilled the criteria of HIRA. Conservative treatment required fractures (score<4) were 52 and borderline fracture (score=4) were 17.
The TLICS system is very useful system for decision of surgical indication in acute traumatic thoracolumbar injury. However, the decision of treatment in TLICS score 4 should be carefully considered. Furthermore, definite criteria of posterior ligamentous complex (PLC) injury may be necessary because the differentiation of PLC injury between TLICS score 2 and 3 is very difficult.


Thoracolumbar spine trauma; Thoracolumbar injury classification and severity score; Denis's classification; Surgical indication

MeSH Terms

Insurance, Health*


  • Fig. 1 Axial CT (A), CT sagittal reconstruction (B), and MR-T2 sagittal (C) showing an T8 burst fracture with lamina fracture in a patient without neurologic deficit. There was no evidence of posterior ligamentous complex (PLC) injury on plain radiographs, CT, or MRI. As a result, this would equal a total Thoracolumbar Injury Classification and Severity Score of 2 (2 points of burst fracture, 0 point of intact neurologic status, 0 of PLC status). We decided to perform surgery because of severe local pain with further kyphotic change and 3 column injured. D and E : The patient underwent posterior T6-10 instrumentation and fusion as seen on plane films. The patient noted back pain improvement and no further kyphotic change after surgical intervention.

Cited by  1 articles

Single-Stage Posterior Subtotal Corpectomy and Circumferential Reconstruction for the Treatment of Unstable Thoracolumbar Burst Fractures
Dae-Jean Jo, Ki-Tack Kim, Sung-Min Kim, Sang-Hun Lee, Myung-Guk Cho, Eun-Min Seo
J Korean Neurosurg Soc. 2016;59(2):122-128.    doi: 10.3340/jkns.2016.59.2.122.


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