Evolution of thoracolumbar trauma classification systems: Assessing the conflict between mechanism and morphology of injury

Spine specialists continue to debate how to best treat various types of thoracolumbar injuries. The first step in standardizing optimal treatment is for orthopedists, neurosurgeons, and rehabilitation specialists to arrive at a consensus regarding the classification of thoracolumbar fractures. Beginning with Böhler in 1931, there have been several attempts to forward thoracolumbar injury classifications systems since the advent of the radiograph. Throughout this period, surgeons and other health care providers have debated whether an effective injury classification system should be based upon the mechanism of injury or the morphology of injured tissues. A systematic review of the literature on thoracolumbar spine trauma classification systems, emphasizing contrasting features of mechanistic and morphometic paradigms, was conducted by 40 spine surgeons from 15 trauma centers in 10 countries. As a contemporary example of this debate, we also discuss 2 recently validated thoracolumbar-fracture classification systems developed by the Spine Trauma Study Group: one is predicated on injury mechanism (Thoracolumbar Injury Severity Score [TLISS]) and the other uses injury morphology (Thoracolumbar Injury Classification and Severity Score [TLICS]).