Thoracolumbar Injury: The Thoracolumbar Injury Classification and Severity Scoring System or Modified Thoracolumbar Injury Classification and Severity?

OBJECTIVE: To compare the Thoracolumbar Injury Clas-sification and Severity (TLICS) scoring system with its modified (mTLICS) version based on their agreement with the surgeon's opinion regarding treatment for patients with thoracolumbar injuries. Moreover, the Posterior Ligamen-tous Complex health was compared between intra-operative examinations and magnetic resonance imaging (MRI) reports. -METHODS: MRI was obtained from 114 patients suffering thoracolumbar spinal trauma; the TLICS and mTLICS scores were measured. Approaches 1 and 2 were designed in both scoring systems based on assuming a total score of 4 as surgery and conservative management indication, respectively. Kappa was used to estimate the agreements between each approach and the surgeon's opinion on treatment. The receiver operating curve calcu-lated the appropriate cut-off scores for the above systems over which surgical management was preferred. A P< 0.05 was considered significant. -RESULTS: All the approaches showed moderate agree-ments with the surgeon's opinion on therapeutic manage-ment (TLICS: Kapproach1 = 0.557, Kapproach2 =0.508; mTLICS: Kapproach1 = 0.557, Kapproach2 = 0.551; P< 0.001 for each K). A score >3.5 best illustrated the indication for surgery in both systems. The radiology report agreed stronger with intraoperatively observed ligamentous health when suspi-cious cases on MRI were reported as injured (KTLICS = 0.830, KmTLICS = 0.704) rather than healthy (KTLICS = 0.620, KmTLICS = 0.620).CONCLUSIONS: The surgeon's treatment plan agreed moderately with suggestions of the TLICS and mTLICS systems; surgery was the preferred management for the patients with a score of 4. Moreover, radiologic suspicion of Posterior Ligamentous Complex injury seemed to indi-cate a damaged ligament rather than a healthy one.