An ideal classification system for thoracolumbar (TL) spine fractures should facilitate communication between treating physicians and guide treatment by means of outlining the natural history of injuries. The classification scheme should also be comprehensive, intuitive, and simple to implement. At the present time, no classification system fully meets these criteria. In this review, the authors attempt to describe the evolution of TL fracture classification systems from their inception to the present day.
The article reviews the salient classification systems that have addressed TL injuries since Boehler’s first attempt in 1929. This progression culminates in the Thoracolumbar Injury Severity Score/Thoracolumbar Injury Classification and Severity Score (TLISS/TLICS), a system which incorporates features from earlier scales and represents the most comprehensive grading scale to date.
Each successive system played an important role in advancing contemporary understanding of TL injuries. Most classifications were, however, based on a single individual’s, or a comparatively small group’s, retrospective review of a case series. In most instances, these grading systems were never validated or modified by their original developers, a shortcoming that prevented their continued evolution. Despite the many advantages of the TLISS/TLICS system, more work in terms of refining the classification and defining its validity remains to be performed.
The classification of TL injuries has evolved significantly over the course of the last 75 years. Most of these schemes were limited by their complexity, relevance, and/or poor reliability. The TLISS classification system represents the most recent evolution as it combines several important factors capable of guiding the management of TL injuries. Nonetheless, more research regarding this rating scale remains to be performed.