{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:21:39Z","timestamp":1793215299970,"version":"4.5.0"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The Thoracolumbar Injury Classification and Severity Score (TLICS) system was developed to streamline injury assessment and guide surgical decision making. To the best of the authors' knowledge, external validation in the pediatric age group has not been undertaken prior to this report.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study evaluated the use of the TLICS in a large retrospective series of children and adolescents treated at 4 pediatric medical centers (Texas Children's Hospital, Children's Healthcare of Atlanta, Riley Children's Hospital, and Doernbecher Children's Hospital). A total of 147 patients treated for traumatic thoracic or lumbar spine trauma between February 1, 2002, and September 1, 2015, were included in this study. Clinical and radiographic data were evaluated. Injuries were classified using American Spinal Injury Association (ASIA) status, Denis classification, and TLICS.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 102 patients (69%) were treated conservatively, and 45 patients (31%) were treated surgically. All patients but one in the conservative group were classified as ASIA E. In this group, 86\/102 patients (84%) had Denis type compression injuries. The TLICS in the conservative group ranged from 1 to 10 (mean 1.6). Overall, 93% of patients matched TLICS conservative treatment recommendations (score \u2264 3). No patients crossed over to the surgical group in delayed fashion.<\/jats:p>\n<jats:p>In the surgical group, 26\/45 (58%) were ASIA E, whereas 19\/45 (42%) had neurological deficits (ASIA A, B, C, or D). One of 45 (2%) patients was classified with Denis type compression injuries; 25\/45 (56%) were classified with Denis type burst injuries; 14\/45 (31%) were classified with Denis type seat belt injuries; and 5\/45 (11%) were classified with Denis type fracture-dislocation injuries. The TLICS ranged from 2 to 10 (mean 6.4). Eighty-two percent of patients matched TLICS surgical treatment recommendations (score \u2265 5). No patients crossed over to the conservative management group. Eight patients (8\/147, 5%) had a calculated TLICS of 4, which meant they were candidates for surgery or conservative therapy by TLICS criteria. Excluding these patients, the degree of agreement between TLICS and surgeon decision was deemed to be very good (\u03ba = 0.878).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The TLICS results and recommendations matched treatment in 96% of conservative group cases. In the surgical group, TLICS recommendations matched treatment in 93% of cases. The TLICS recommendations and surgeon decision making displayed very good concordance. The TLICS appears to be effective in the classification of thoracic and lumbar spine injuries and in guiding treatment in the pediatric age group.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.1.peds15663","type":"journal-article","created":{"date-parts":[[2016,4,9]],"date-time":"2016-04-09T00:55:03Z","timestamp":1460163303000},"page":"164-170","source":"Crossref","is-referenced-by-count":26,"title":["Multicenter retrospective evaluation of the validity of the Thoracolumbar Injury Classification and Severity Score system in children"],"prefix":"10.3171","volume":"18","author":[{"given":"Jonathan N.","family":"Sellin","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Steele","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Simpson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Doernbecher Children's Hospital, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei X.","family":"Huff","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, Indiana; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon C.","family":"Lane","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, Indiana; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua J.","family":"Chern","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Emory University, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Fulkerson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Riley Children's Hospital, Indianapolis, Indiana; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M.","family":"Sayama","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Doernbecher Children's Hospital, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds15663","series-title":"Orthop Clin North Am","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/S0030-5898(05)70103-6","article-title":"Pediatric spine fractures","volume":"30","author":"Akbarnia","year":"1999"},{"key":"b2-peds15663","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1097\/00007632-198311000-00003","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983"},{"key":"b3-peds15663","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1760","DOI":"10.1016\/j.spinee.2013.03.014","article-title":"Retrospective evaluation of the validity of the Thoracolumbar Injury Classification System in 458 consecutively treated patients","volume":"13","author":"Joaquim","year":"2013"},{"key":"b4-peds15663","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/BRS.0b013e3181c95047","article-title":"Evaluation of the thoracolumbar injury classification system in thoracic and lumbar spinal trauma","volume":"36","author":"Joaquim","year":"2011"},{"key":"b5-peds15663","series-title":"J Orthop Sci","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1007\/s00776-005-0956-y","article-title":"Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma","volume":"10","author":"Lee","year":"2005"},{"key":"b6-peds15663","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1007\/BF02221591","article-title":"A comprehensive classification of thoracic and lumbar injuries","volume":"3","author":"Magerl","year":"1994"},{"key":"b7-peds15663","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.2106\/00004623-197456080-00016","article-title":"Hyperextension injuries of the cervical spine. 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