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:
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!
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.
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
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
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.
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.
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).
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.
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.
12/Here is the summary of the scoring for PLC injury in TLICS. Edema is suspicious, but only a true gap is considered injured.
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!
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1/Have MULTIPLE questions about the new criteria for MULTIPLE sclerosis?
ECTRIMS 2024 just came out w/proposed new changes to the McDonald criteria for multiple sclerosis.
The changes are complex, but here is a thread w/the basics that you NEED to know!
2/The 2017 criteria were complex as well, but the basic theme was that they required dissemination in both time & space.
So you needed lesions in multiple locations and of multiple different ages.
3/Proposed new criteria bring a paradigm shift from relying on a combination of dissemination in both space in time, to relying on other factors that can replace dissemination in time
It also proposes that new imaging features specific to MS can be used in diagnosis as well
How back pain radiates can tell you where the lesion is—if you know where to look!
Do YOU know where to look?
Here’s how to remember the lumbar radicular pain distributions!
2/Why is it important to know the radicular pain distributions?
Most times patients have many POSSIBLE sources of pain--and when you are looking at an MRI, it's your job to decide which finding is the most LIKELY source of pain
These pain distributions can help you do that!
3/Let’s start with L1. L1 radiates to the groin.
I remember that b/c the number 1 is, well, um…phallic.
1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!
How do you grade it?
Do you estimate? Measure? Guess???
Here’s a thread about a lumbar grading system that’s easy, reproducible & evidence-based!
2/Lumbar stenosis has always been controversial.
In 2012, they tried to survey spine experts to get a consensus as to what are the most important criteria for canal & foraminal stenosis.
And the consensus was…that there was no consensus
So what should you use to call it?
3/Well, you don’t want just gestalt it—that is a recipe for inconsistency & disagreement
But you don’t want to measure everything either—measurements are not only cumbersome, they introduce reader variability & absolute measurements don’t mean the same thing in every patient.