Relationships between the arbeitsgemeinschaft für osteosynthesefragen spine system and the thoracolumbar injury classification system: An analysis of the literature

Context: The Thoracolumbar Injury Classification System (TLICS) has been recently described to help surgeons in the decision-making process of thoracolumbar spinal trauma. Objective: To analyze the potential relationships between the TLICS scores with the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine System and patient's neurological status. Methods: Literature analysis of the potential scored injuries in the TLICS system, based on its individual scores, its total score, and its suggested proposed treatment, correlating these with the AO system and neurological status. Results: Findings are presented according to the TLICS score. Patients with a TLICS 1-3 points, receiving conservative treatment, are AO type A injuries, generally neurologically intact. TLICS 4 group also included AO type A fractures, neurologically ranging from intact to complete spinal cord injury. TLICS 5-10 points includes AO type B and C injuries, regarding their neurological status, and burst fractures (AO type A) with concomitant neurological injury and most of the patients with incomplete deficits and cauda equina syndrome. Conclusions: As a general overview, according to the TLICS, patients without neurological deficit and with AO type A injuries are conservatively treated. AO type B and C injuries are managed surgically, with regard to neurological status. Patients with cauda equina or incomplete injuries also received a higher severity score. Controversies still exist regarding the management of unstable burst fractures without neurological status. The role of the posterior ligamentous complex status and the magnetic resonance imaging in the decision-making process require more clinical evidence.