Table 1.

Management and choice of approach

Management	Points
Nonoperative	Less than 3
Nonoperative or Operative	4
Operative	Greater than 4
Operative Approach Algorithm
Neurological Status	PLC Intact	PLC Disrupted
Intact	Posterior approach	Posterior approach
Root Injury	Posterior approach	Posterior approach
Incomplete cord or cauda equina	Anterior approach	Combined
Complete cord or cauda equina	Posterior or combined	Posterior or combined

Summation of the TLISS points are referred to a management algorithm illustrated above. If the summation is less than 3 points than typically non-operative treatment is suggested, points greater then 5 suggest severe instability and the need for operative treatment. In addition a summation of four pints required further analysis on the patient concurrent modifiers and medical comorbidities. Taken from Vaccaro AR, Lehman RA, et al. and Harrop J, Vaccaro AR, et al [8,21].