Thoracolumbar Injury Classification and Injury Severity Score

This score was proposed by Vaccaro et al  to assist in the determination of when operative treatment of the thoracolumbar spine is appropriate.This score needs still further validation.

Score is developed from an algorithm in which points are collected in a sequential evaluation of the injury.

The items considered in order are

1. The fracture mechanism

2. The integrity of the posterior ligament complex,

3. The neurological status of the patient.

A point value is assigned to each segment of the three injury components, and these points are added. Patients with scores of 3 or less should do well with nonoperative treatment, whereas patients with scores of 5 or more require surgery. Nonoperative or operative treatment may be appropriate for patients with 4 points.

Points are given as follows.

Fracture Mechanism

Compression fracture 1
Burst fracture 1
Translation/rotation 3
Distraction 4

Neurological Involvement

Intact 0
Nerve root 2
Cord, conus medullaris, incomplete 3
Cord, conus medullaris, complete 2
Cauda equina 3

Posterior Ligamentous Complex Integrity

Intact 0
Injury suspected/indeterminate 2
Injured 3

Score of 3 or less—nonoperative treatment
Score of 5 ormore —operative treatment
Score of 4—either nonoperative or operative treatment depending upon associated condtions

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