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How can you tell if someone with a spinal fracture needs to have surgery? My sister has a fracture at the T12-L1 level. The surgeons are trying to decide if she needs a cast vs. surgery.
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Thoracolumbar refers to the spot in the spine where the thoracic vertebrae end (T12) and the lumbar vertebrae begin (L1). That point (T12-L1) is called the thoracolumbar junction. Fractures affecting one level above (T11) and one level below (L2) are also included in this category.
Surgeons often use what's called a classification system to help them identify the location and severity of spinal fractures. Some classification systems also include the mechanism of injury (how it happened). That information is what they use to determine the most appropriate treatment for each patient.
A new system called the Thoracolumbar Injury Classification and Severity Score (TLICS) has been proposed for fractures like you describe. Points are given for three basic characteristics of the injury: type of injury, neurologic status, and condition of the spinal ligaments. For example, a simple compression fracture would be assigned one point. A burst compression fracture would get an additional point for a subtotal of two points.
If the X-ray or other imaging studies show a rotation or translation of the segment, that's another three points. Four points are added to the subtotal if the fracture has separated and the two ends of the fracture have moved apart.
Values ranging from zero to three are given based on morphology (type of injury: compression, burst) neurologic status (spinal cord or nerve root involvement), and ligament integrity (intact, torn).
The condition of thse soft tissues is important because they can create additional problems if not treated. For example, a distracted fracture with jagged edges increases the risk for nerve damage. A partially or fully torn ligament puts the patient at risk for instability.
The points are all totaled and the final value (indicating severity) guides treatment. Less than four points suggests a nonsurgical approach to treatment is possible. More than four points requires surgery. Patients with zero to four points fall in the middle: they could be candidates for surgical or nonsurgical treatment. In those middle-of-the-road patients, the surgeon must evaluate all factors before making the final treatment decision.
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