Introducing a 61-year old woman who was suffering from complicated traumatic thoracolumbar spine fractures, we contemplated the appropriate management algorithm. The Thoracolumbar Injury Classification and Severity score (TLICS) system is the latest and widely used scoring system by spine surgeons for thoracolumbar injuries (TLI). The originator of the system claims for easy application, high reproducibility, and direct link to a clinical decision-making algorithm. However, because of its simple and narrow boundaries, there are many limitations to apply the system in complicated situations. Besides, a fair number of TLI are caused by high velocity traumas, which mostly lead to complicated fractures and other medical conditions. For these reasons, practically, we also consider traditional and former concepts of TLI classifications. Furthermore, new algorithm should be suggested which includes not only the spine morphology and neurological manifestation but also comprehensive medical considerations of the patient.