Lea Alhilali, MD Profile picture
Jun 9, 2023 13 tweets 7 min read Read on X
1/Remembering spinal fracture classifications is back breaking work!

A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!

#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery Image
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury. Let's start w/morphology. TLICS scores severity like the steps to make & eat a pizza:

Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in) Image
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.

This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin! Image
4/As the axial force grows, this becomes a burst fx with retropulsion of the posterior vertebral body—just as greater force causes more comminution in long bone fxs.

This is like moving up from your hands to the rolling pin. A burst is worth 2 points. Image
5/If the force is shearing, you rip the connection between the vertebral bodies—it's is the equivalent of pulling on a long bone & causing its dislocation from its joint or connection with another bone

This is like when you throw the pizza up into the air. This is worth 3 points Image
6/Similar to shear forces, distracting forces rip the vertebral bodies apart. But rather than sliding forward or back, vertebral bodies are pulled up or down, resulting in a vertical gap between the vertebrae.

It is like tearing the pizza apart to eat it. It is worth 4 points Image
7/This summarizes the TLICS scoring for fracture morphology. The higher the number, the greater the force and injury to the spine—ranging from simple compression fxs worth only 1 point to where the spine is literally ripped apart—a distraction injury, worth 4 points. Image
8/The next TLICS imaging finding is the integrity of the PLC. If it is intact, you get 0 pts. If you needed a tweetorial for that, well…I can’t help you much. If there is edema, but no true rupture on MRI, that is worth 2 pts. True disruption on MRI is worth 3 pts. Image
9/The difference between suspected injury & injured is like the difference of seeing smoke & suspecting fire (you see edema on MR & suspect injury) and actually seeing the fire (seeing the ligamentous tear as disruption of the T2 dark line of the ligament on MR). Image
10/ Here is an example of suspected injury—edema is seen in the posterior ligamentous complex, but the T2 dark lines that are the ligaments themselves appear intact. This is worth 2 pts. Image
11/If you can find a true disruption or gap in the T2 dark line of the ligament, that is considered truly disrupted and worth 3 points. Image
12/Here is the summary of the scoring for PLC injury in TLICS. Edema is suspicious, but only a true gap is considered injured. Image
13/So now you know how to score imaging findings in thoracolumbar fxs--I hope that takes a load off your back!

Remember, it's as easy as pizza pie! Image

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Jul 2
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Does seeing an infarct in the medulla cause your heart to skip a beat?

Does medullary anatomy send you into respiratory arrest?

Never fear, here is a thread on the major medullary syndromes! Image
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Everything going down into the cord must pass through the medulla & everything from the cord going back up to the brain must too.

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If you don’t know the time of stroke onset, are you able to deduce it from imaging?

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The appearance of stroke on imaging mirrors the life stages of a person—you just have to change days for a stroke into years for a person

So 15 day old stroke has features of a 15 year old person, etc. Image
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Jun 27
1/”I LOVE spinal cord syndromes!” is a phrase that has NEVER, EVER been said by anyone.

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Never fear—here is a thread on all the incomplete spinal cord syndromes to get you moving again! Image
2/Spinal cord anatomy can be complex. On imaging, we can see the ant & post nerve roots. We can also see the gray & white matter. Hidden w/in the white matter, however, are numerous efferent & afferent tracts—enough to make your head spin. Image
3/Lucky for you, for the incomplete cord syndromes, all you need to know is gray matter & 3 main tracts. Anterolaterally, spinothalamic tract (pain & temp). Posteriorly, dorsal columns (vibration, proprioception, & light touch), & next to it, corticospinal tracts—providing motor Image
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Jun 23
1/Do you get a Broca’s aphasia trying remember the location of Broca's area?

Does trying to remember inferior frontal gyrus anatomy leave you speechless?

Don't be at a loss for words when it comes to Broca's area

Here’s a 🧵to help you remember the anatomy of this key region! Image
2/Anatomy of the inferior frontal gyrus (IFG) is best seen on the sagittal images, where it looks like the McDonald’s arches.

So, to find this area on MR, I open the sagittal images & scroll until I see the arches. When it comes to this method of finding the IFG, i’m lovin it. Image
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Jun 19
1/Feeling intoxicated trying to remember all the findings in alcohol use disorder?!

Here’s something to put you in high spirits!

This month’s @Radiographics has the important neuroimaging findings alcohol use disorder!



@cookyscan1 @RadG_editor #RGphx pubs.rsna.org/doi/10.1148/rg…Image
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“Basal ganglia is white...”

Get intrinsic T1 shortening in the BG that makes it look white as a ghost! Image
3/Next “...Cortex is bright”

Acute hyperammonemic encephalopathy cause cortical restricted diffusion, especially the insula, so that it looks as bright as a light bulb! Image
Read 8 tweets
Jun 9
1/Need help reading spine imaging? I’ve got your back!

It’s as easy as ABC!

A thread about an easy mnemonic you can use on every single spine study you see to increase your speed & make sure you never miss a thing! Image
2/A is for alignment

Look for:
(1) Unstable injuries

(2) Malalignment that causes early degenerative change. Abnormal motion causes spinal elements to abnormally move against each other, like grinding teeth wears down teeth—this wears down the spine Image
3/B is for bones.

On CT, the most important thing to look for w/bones is fractures. You may see focal bony lesions, but you may not

On MR, it is the opposite—you can see marrow lesions easily but you may or may not see edema associated w/fractures if the fracture is subtle Image
Read 11 tweets

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