We are trying to help Mom guide Dad to a decision about surgery for his spine. As it has been told to us, he has a burst fracture of the T9 vertebral bone. With metal rods the surgeon can hold it in place until it heals. Dad is afraid the rods will slip or break. Does this ever really happen? Is there some way to reassure him that all will be well?

Surgical treatment of burst fractures has been reported successful in the majority of patients. The most likely surgical approach is spinal fusion. The fusion may (or may not) require the use of hardware such as metal plates, rods, screws or wires. Use of these devices is called instrumentation or fixation.

The real challenge is in deciding which approach to use (anterior, posterior, or a combination of both) for the best results. A new classification system has been developed to help guide surgeons in this decision-making process. It is called the Thoracolumbar Injury Classification and Severity (TLICS) System.

The TLICS guides the surgeon in making the best decision for each individual patient. It takes into consideration 1) the type of fracture you have and 2) any neurologic problems present as a result of the fracture. The TLICS also takes into account 3) whether or not the ligaments supporting the spine are damaged leaving the spine unstable.

The goal of surgery is to stabilize the spine but also provide long-lasting good spinal alignment without deformity or loss of correction. After surgery, loss of spinal alignment and the development of spinal deformities can be evaluated and given a number based on severity. Likewise, neurologic status and spinal stability can be rated and classified.

The TLICS system is a reliable and evidence-based tool for directing treatment of thoracolumbar burst fractures. It doubles as a guiding tool for who needs surgery and will eventually reveal which surgery is advised for each patient.

The added value of such a system is in tracking the results of minimally invasive surgeries. And minimally invasive can mean less time in surgery, low blood loss, faster return-to-home, and fewer neurologic complications. Metal rods placed in the spine can (and sometimes do) break or shift position. Predicting when this might happen has not been possible until now.

A tool like the TLICS can be used in research to study optimal surgical methods for burst fractures. Surgeons can use this tool to track results and compare them when using one of several different surgical techniques. In the future, it may be possible to predict who will develop specific types of complications like rod breakage. For now surgeons rely on their experience and knowledge or certain risk factors (e.g., brittle bones) when making treatment decisions about when to use fixation devices and what type are best.