J Am Acad Orthop Surg, Vol 18, No 2, February 2010 Alpesh A. Patel, MD and Alexander R. Vaccaro, MD, PhD Thoracolumbar spine trauma is among the most common musculoskeletal injuries worldwide. However, there is little consensus on the adequate management of spine injury, in part because there is no widely accepted classification system. Several systems have been developed based on injury anatomy or inferred mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. The Thoracolumbar Injury Classification and Severity Score (TLICS) was developed to address these limitations. The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in medical decision making. Initial application of the TLICS has shown good to excellent reliability and validity. Additional evaluation of the TLICS is needed to prospectively define its clinical utility and identify potential limitations.