Vaccaro et al developed a thoracolumbar injury severity score for evaluating a patient with thoracolumbar injuries. The authors are from multiple universities in the United States and Europe.
Parameters:
(1) mechanism and/or fracture pattern
(1a) compression injuries with or without burst and/or lateral angulation
(1b) translational/rotational injuries
(1c) distraction injuries
(2) integrity of the posterior ligamentous complex on MRI imaging
(3) patient's neurologic status
|
Mechanism/Fracture |
Finding |
Points |
|
compression injuries |
none |
0 |
|
|
compression alone |
1 |
|
|
compression + burst injury |
2 |
|
|
compression + lateral angulation > 15° |
2 |
|
|
compression + burst injury + lateral angulation > 15° |
3 |
|
translation/rotation injuries |
absent |
0 |
|
|
present |
3 |
|
distraction injuries |
absent |
0 |
|
|
present |
4 |
where:
• If there are injuries at multiple levels, then only the level with the most severe injuries is scored.
• Compression fractures involve failure of the vertebral body after axial loading.
• Burst injury involves disruption of the posterior cortex.
• Translational-rotational injuries are caused by torsion and shear forces and can result in significant instability.
• Distraction injury implies failure under tensile stress and is unstable.
subscore for mechanism/fracture =
= SUM(points for all of the findings)
|
Posterior Ligament |
Points |
|
no injury |
0 |
|
incomplete injury |
2 |
|
definite injury |
3 |
|
Neurologic Status |
Points |
|
intact (no injuries) |
0 |
|
root injury |
2 |
|
incomplete spinal cord or cauda equina |
3 |
|
complete spinal cord injury |
2 |
where:
• Alternatively the root injury and spinal cord injury can be scored separately.
subscore for neurologic status =
= (points for root injury) + (points for spinal cord injury)
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• A patient with a higher score is more likely to benefit from surgical decompression.
|
Total Score |
Management |
|
0 to 3 |
nonsurgical management |
|
4 |
either |
|
>= 5 |
surgery |
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
ICD-10: ,
