To The ediTor: The thoracolumbar junction is uniquely predisposed to injury as a result of the significant forces exerted over the relatively short spinal segment as the spine transitions from a kyphotic thoracic posture to a lumbar lordosis. In the transitional thoracolumbar segment (T10–L2) the body’s center of gravity moves from anterior to posterior relative to the anterior spinal column, with the load consequently shifting from the anterior column to the posterior elements. In this transitional region the thoracic ribcage no longer serves as a buttress, and the lumbar spine has not yet transitioned to its full lordosis, with a concomitant shift of the load to the more sagittally oriented facets.2 Historically there have been multiple descriptive and mechanistic classification systems for thoracolumbar injuries. These systems have evolved with an increased understanding of spinal biomechanics afforded by advances in clinical imaging. The goal of a classification system is to facilitate accurate description and communication of the salient features of an injury between investigators and clinicians; consequently, any classification system must be validated for interand intraobserver reproducibility. To be of clinical utility, the information conveyed in a classification system should aid the physician in guiding treatment. Due to the complexity of existing classification systems, concerns about interand intraobserver reproducibility, the lack of inclusion of neurological status, and the need for clinical guidelines, the Spine Trauma Study Group developed a classification system for thoracolumbar injuries that builds on concepts from prior systems with an aim to be more applicable to clinical decision making. The goal was to develop a system that is easy to use, easy to communicate, incorporates key decision making considerations, and facilitates clinical decision making. The Thoracolumbar Injury Classification and Severity Scale (TLICSS) assesses each injury according to its morphological characteristics, the integrity of the posterior ligamentous complex, and neurological status of the patient. The severity of the injury and consequent treatment recommendations are guided by assigning a point score to each of these features.4,5 Injuries are classified by morphological characteristics as compression fracture (1 point), burst fracture (2 points), translational or rotational injuries (3 points), or distraction injuries (4 points.) The posterior ligamentous complex is assessed on MR images or CT scans and classified as intact (0 points), suspected injury (2 points), or confirmed injury (3 points.) Neurological status is assessed as intact (0 points), nerve root injury (2 points), complete neurological injury (American Spinal Injury Association scale Grade A, 2 points), incomplete neurological injury (American Spinal Injury Association scale Grades B, C, and D) or cauda equina (3 points.) The scores in each category are summed to yield the overall severity score, ranging from 1 to 10. Injuries with a severity score of ≤ 3 are likely candidates for nonoperative treatment, while injuries with a severity score of ≥ 5 probably require surgical stabilization. Injuries with a severity score of 4 are indeterminate with regard to the need for surgical intervention, and treatment considerations are based on clinical qualifiers. Clinical qualifiers include extreme kyphosis, marked spinal collapse, lateral angulation, open fractures, soft tissue compromise, adjacent rib fractures, inability to brace, multisystem trauma, severe head injury, and sternum fracture. An earlier version of this classification system (Thoracolumbar Injury Severity Scale) also considered injury mechanism, but it was found that mechanism of injury had the greatest interobserver variability. Consequently, this factor was removed from the system and the focus was turned to the morphological characteristics of the injury.3 The 2 cases of a unilateral thoracolumbar facet dislocation presented by Reddy and colleagues are illustrative of the utility of the TLICSS system. The patient in Case 1 had a TLICSS score of 9: 3 (translational/rotational) + 3 (disrupted posterior ligamentous complex) + 3 (cord/ medullary conus injury, incomplete). The patient in Case 2 also has a TLICSS score of 9, but with additional clinical qualifiers. A severity score of 9 probably necessitates surgical intervention in the absence of precluding clinical qualifiers. As the authors noted, resection of the facet was necessary to achieve reduction in both cases, and it is important to emphasize this. Conceptually these fractures can be viewed as a failure of the posterior ligamentous complex, which allowed a flexion-distraction force to dislocate the facet with consequent spondylolisthesis. At presentation, the injury morphology was one of lateral spondylolisthesis resulting from lateral facet dislocation, and the posterior ligamentous instability is highlighted by the anterolisthesis in Case 2 when the patient was positioned prone on a Jackson table. See the corresponding article in this issue, pp 576–580.