# Fractura toracolumbar: clasificar con TLICS y AO Spine, y decidir cuándo operar — guion de ponencia *Guion de ponencia de 10 minutos · Dr. Anthony Cevallos · Biblioteca Traumatología y Ortopedia · https://t.cescac.com/tema/fractura-toracolumbar-tlics/ · actualizado el 14 de octubre de 2026* > Material educativo para profesionales y estudiantes de medicina; no reemplaza el juicio clínico, las guías institucionales ni la supervisión del tutor. ## Guion (10 minutos) Lámina 1 (1 min): caso de apertura. Varón joven tras caída desde altura, dolor lumbar alto, sin déficit. Tres preguntas: ¿qué se rompió?, ¿hay déficit?, ¿se opera? Lámina 2 (1 min): dónde y cuántas. 30 por 100 000 al año; unión T12-L2 [r39][r40][r9]. *Fuentes de esta lámina:* [r9] Soultanis K et al. Injury. 2021. doi:10.1016/j.injury.2021.05.019; [r39] Jansson KA et al. Eur J Epidemiol. 2010. doi:10.1007/s10654-010-9461-5; [r40] Zileli M et al. Neurospine. 2021. doi:10.14245/ns.2142418.209 Lámina 3 (1 min): AO Spine en 3 pasos: C, B, A; neurología N0 a N4; modificadores M1 y M2 [r4][r2]. *Fuentes de esta lámina:* [r2] Costachescu B et al. J Clin Med. 2022. doi:10.3390/jcm11092498; [r4] AO Foundation. 2026. Lámina 4 (1 min): TLICS: morfología, CLP y neurología; 3 o menos, 4, 5 o más [r1][r2]. *Fuentes de esta lámina:* [r1] Vaccaro AR et al. Spine (Phila Pa. 2005. doi:10.1097/01.brs.0000182986.43345.cb; [r2] Costachescu B et al. J Clin Med. 2022. doi:10.3390/jcm11092498 Lámina 5 (1 min): reproducibilidad. Kappa de 0,56 global en AO Spine; 0,29 el total de TLICS; 0,11 el CLP en tipo A [r10][r11][r12]. *Fuentes de esta lámina:* [r10] Kepler CK et al. Eur Spine J. 2016. doi:10.1007/s00586-015-3765-9; [r11] Kaul R et al. Eur Spine J. 2017. doi:10.1007/s00586-016-4663-5; [r12] Schroeder GD et al. Global Spine J. 2015. doi:10.1055/s-0035-1549034 Lámina 6 (1 min): imagen. TC con 97,2 % de sensibilidad frente a 33,3 % de la radiografía; criterios de TC para el CLP; RM cambió la decisión en 22 % [r7][r26][r17]. *Fuentes de esta lámina:* [r7] Wintermark M et al. Radiology. 2003. doi:10.1148/radiol.2273020592; [r17] Aly MM et al. Eur Spine J. 2024. doi:10.1007/s00586-023-08087-4; [r26] Aly MM et al. Neurosurgery. 2025. doi:10.1227/neu.0000000000003263 Lámina 7 (1 min): ensayos. Shen, Siebenga y Wood; Cochrane: 2 ensayos, 87 participantes, evidencia contradictoria [r46][r14][r15][r38]. *Fuentes de esta lámina:* [r14] Siebenga J et al. Spine (Phila Pa. 2006. doi:10.1097/01.brs.0000247804.91869.1e; [r15] Wood KB et al. J Bone Joint Surg Am. 2015. doi:10.2106/JBJS.N.00226; [r38] Abudou M et al. Cochrane Database Syst Rev. 2013. doi:10.1002/14651858.CD005079.pub3; [r46] Shen WJ et al. Spine (Phila Pa. 2001. doi:10.1097/00007632-200105010-00010 Lámina 8 (1 min): metaanálisis de 19 estudios y ortesis: poca diferencia; ortesis equivalente a ninguna [r13][r32][r65]. *Fuentes de esta lámina:* [r13] Chou TY et al. Global Spine J. 2024. doi:10.1177/21925682231181875; [r32] Bailey CS et al. Spine J. 2014. doi:10.1016/j.spinee.2013.10.017; [r65] Urquhart JC et al. J Neurosurg Spine. 2017. doi:10.3171/2016.11.SPINE161031 Lámina 9 (1 min): si se opera: momento, abordaje posterior, segmento corto con tornillo en la fracturada, sin fusión obligatoria, percutáneo [r16][r53][r21][r22][r33]. *Fuentes de esta lámina:* [r16] Hsieh YL et al. J Neurotrauma. 2021. doi:10.1089/neu.2021.0102; [r21] Sharif S et al. Neurospine. 2021. doi:10.14245/ns.2142206.253; [r22] Chi JH et al. Neurosurgery. 2019. doi:10.1093/neuros/nyy364; [r33] Tian F et al. Medicine (Baltimore). 2018. doi:10.1097/MD.0000000000012535; [r53] Hartensuer R et al. Eur J Trauma Emerg Surg. 2025. doi:10.1007/s00068-024-02759-6 Lámina 10 (1 min): complicaciones y pronóstico: 21 de 41 frente a 6 de 38; fracaso conservador de 3,8 % a 9,2 %; regreso al trabajo de 76 % a 84 % [r38][r19][r31][r29]. *Fuentes de esta lámina:* [r19] Tan T et al. Global Spine J. 2022. doi:10.1177/21925682211031207; [r29] Suijkerbuijk M et al. Acta Orthop. 2026. doi:10.2340/17453674.2026.45364; [r31] Taddei G et al. Eur Spine J. 2026. doi:10.1007/s00586-026-10402-8; [r38] Abudou M et al. Cochrane Database Syst Rev. 2013. doi:10.1002/14651858.CD005079.pub3 ## Mensajes clave - Clasifica con 3 preguntas en orden (traslación, banda de tensión, cuerpo) y añade neurología y modificadores [r4][r2]. - Los tipos B y C y el déficit neurológico empujan a operar; el estallido sin déficit es la zona gris y la evidencia es de certeza muy baja [r5][r13]. - Si se opera, lo posterior, corto, con tornillo en la fracturada y sin fusión obligatoria alcanza en muchos casos [r21][r22]. ## Referencias - **[r1]** Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005;30(20):2325-33. doi:10.1097/01.brs.0000182986.43345.cb - **[r2]** Costachescu B, Popescu CE, Iliescu BF. Analysis of the Classification Systems for Thoracolumbar Fractures in Adults and Their Evolution and Impact on Clinical Management. J Clin Med. 2022;11(9). doi:10.3390/jcm11092498 - **[r4]** AO Foundation. AO Spine thoracolumbar injury classification system. En: AO Surgery Reference, Thoracic and lumbar trauma [Internet]. Davos: AO Foundation; [consultado 2026 oct 14]. Disponible en: https://surgeryreference.aofoundation.org/spine/trauma/thoracolumbar/further-reading/rationale-for-fracture-classification-a0-a1-a2-a3-a4-b1-b2-b3-c - **[r5]** Peev N, Zileli M, Sharif S, Arif S, Brady Z. Indications for Nonsurgical Treatment of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine. 2021;18(4):713-724. doi:10.14245/ns.2142390.195 - **[r7]** Wintermark M, Mouhsine E, Theumann N, Mordasini P, van Melle G, Leyvraz PF, et al. Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology. 2003;227(3):681-9. doi:10.1148/radiol.2273020592 - **[r9]** Soultanis K, Thano A, Soucacos PN. "Outcome of thoracolumbar compression fractures following non-operative treatment". Injury. 2021;52(12):3685-3690. doi:10.1016/j.injury.2021.05.019 - **[r10]** Kepler CK, Vaccaro AR, Koerner JD, Dvorak MF, Kandziora F, Rajasekaran S, et al. Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons. Eur Spine J. 2016;25(4):1082-6. doi:10.1007/s00586-015-3765-9 - **[r11]** Kaul R, Chhabra HS, Vaccaro AR, Abel R, Tuli S, Shetty AP, et al. Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study. Eur Spine J. 2017;26(5):1470-1476. doi:10.1007/s00586-016-4663-5 - **[r12]** Schroeder GD, Kepler CK, Koerner JD, Oner FC, Fehlings MG, Aarabi B, et al. A Worldwide Analysis of the Reliability and Perceived Importance of an Injury to the Posterior Ligamentous Complex in AO Type A Fractures. Global Spine J. 2015;5(5):378-82. doi:10.1055/s-0035-1549034 - **[r13]** Chou TY, Tsuang FY, Hsu YL, Chai CL. Surgical Versus Non-Surgical Treatment for Thoracolumbar Burst Fractures Without Neurological Deficit: A Systematic Review and Meta-Analysis. Global Spine J. 2024;14(2):740-749. doi:10.1177/21925682231181875 - **[r14]** Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, et al. Treatment of traumatic thoracolumbar spine fractures: a multicenter prospective randomized study of operative versus nonsurgical treatment. Spine (Phila Pa 1976). 2006;31(25):2881-90. doi:10.1097/01.brs.0000247804.91869.1e - **[r15]** Wood KB, Buttermann GR, Phukan R, Harrod CC, Mehbod A, Shannon B, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am. 2015;97(1):3-9. doi:10.2106/JBJS.N.00226 - **[r16]** Hsieh YL, Tay J, Hsu SH, Chen WT, Fang YD, Liew CQ, et al. Early versus Late Surgical Decompression for Traumatic Spinal Cord Injury on Neurological Recovery: A Systematic Review and Meta-Analysis. J Neurotrauma. 2021;38(21):2927-2936. doi:10.1089/neu.2021.0102 - **[r17]** Aly MM, Soliman Y, Elemam RA, Pizones J, Alzahrani A, Elwatidy S. How frequently MRI modifies thoracolumbar fractures' classification or decision-making? A systematic review and meta-analysis. Eur Spine J. 2024;33(4):1540-1549. doi:10.1007/s00586-023-08087-4 - **[r19]** Tan T, Huang MS, Rutges J, Marion TE, Fitzgerald M, Hunn MK, et al. Rate and Predictors of Failure in the Conservative Management of Stable Thoracolumbar Burst Fractures: A Systematic Review and Meta-Analysis. Global Spine J. 2022;12(6):1254-1266. doi:10.1177/21925682211031207 - **[r21]** Sharif S, Shaikh Y, Yaman O, Zileli M. Surgical Techniques for Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine. 2021;18(4):667-680. doi:10.14245/ns.2142206.253 - **[r22]** Chi JH, Eichholz KM, Anderson PA, Arnold PM, Dailey AT, Dhall SS, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Evaluation and Treatment of Patients With Thoracolumbar Spine Trauma: Novel Surgical Strategies. Neurosurgery. 2019;84(1):E59-E62. doi:10.1093/neuros/nyy364 - **[r26]** Aly MM, Abdelaziz M, Alfaisal FA, Alrumian RA, Espinoza XAS, Gutiérrez-González R, et al. Multicenter External Validation of the Accuracy of Computed Tomography Criteria for Detecting Thoracolumbar Posterior Ligamentous Complex Injury. Neurosurgery. 2025;96(6):1236-1248. doi:10.1227/neu.0000000000003263 - **[r29]** Suijkerbuijk M, Cranenbroek D, Van Ameijden SI, Van Egmond PW, Joosen MCW, De Jongh MAC, et al. Return to work following traumatic fractures of the thoracolumbar spine without spinal cord injury: a scoping review. Acta Orthop. 2026;97:83-90. doi:10.2340/17453674.2026.45364 - **[r31]** Taddei G, Pietrantonio A, Petrella G, Toccaceli G, Piragine G, Mastino L, et al. Predictors of failure of non-operative management in neurologically intact thoracolumbar burst fractures: a systematic review and meta-analysis. Eur Spine J. 2026. doi:10.1007/s00586-026-10402-8 - **[r32]** Bailey CS, Urquhart JC, Dvorak MF, Nadeau M, Boyd MC, Thomas KC, et al. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures without neurologic injury: a multicenter prospective randomized equivalence trial. Spine J. 2014;14(11):2557-64. doi:10.1016/j.spinee.2013.10.017 - **[r33]** Tian F, Tu LY, Gu WF, Zhang EF, Wang ZB, Chu G, et al. Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(41):e12535. doi:10.1097/MD.0000000000012535 - **[r38]** Abudou M, Chen X, Kong X, Wu T. Surgical versus non-surgical treatment for thoracolumbar burst fractures without neurological deficit. Cochrane Database Syst Rev. 2013;2013(6):CD005079. doi:10.1002/14651858.CD005079.pub3 - **[r39]** Jansson KA, Blomqvist P, Svedmark P, Granath F, Buskens E, Larsson M, et al. Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital. Eur J Epidemiol. 2010;25(6):431-7. doi:10.1007/s10654-010-9461-5 - **[r40]** Zileli M, Sharif S, Fornari M. Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine. 2021;18(4):704-712. doi:10.14245/ns.2142418.209 - **[r46]** Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976). 2001;26(9):1038-45. doi:10.1097/00007632-200105010-00010 - **[r53]** Hartensuer R, Weise A, Breuing J, Bieler D, Sprengel K, Huber-Wagner S, et al. Initial surgical management of spinal injuries in patients with multiple and/or severe injuries- the 2022 update of the German clinical practice guideline. Eur J Trauma Emerg Surg. 2025;51(1):70. doi:10.1007/s00068-024-02759-6 - **[r65]** Urquhart JC, Alrehaili OA, Fisher CG, Fleming A, Rasoulinejad P, Gurr K, et al. Treatment of thoracolumbar burst fractures: extended follow-up of a randomized clinical trial comparing orthosis versus no orthosis. J Neurosurg Spine. 2017;27(1):42-47. doi:10.3171/2016.11.SPINE161031