ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicNavigating Uncertainty in Polytrauma and Associated Spine InjuriesView all articles
Is the modified thoracolumbar injury classification and severity score superior to the thoracolumbar AOSpine injury score when guiding thoracolumbar fracture surgery?
Provisionally accepted
Han Zhang1Jun-Wei Feng1
Bing Wu1Jia-Yi Dou1Chen Chen2Kai-Feng Lin1Fang-Zhou Sun1
Binbin Tang2
Lianguo Wu2Jin-Zhan Su2Li-Qiang Dong2
Zhong-Cheng An2*- 1The Second School of Clinical Medicine of Zhejiang Chinese Medical University, HangZhou, China
- 2Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
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Purpose: To compare the consistency and differences between the modified Thoracolumbar Injury Classification and Severity Score (mTLICS) system and the AO Thoracolumbar Spine Injury Score (TL AOSIS) in guiding surgical decision-making for thoracolumbar fractures. Methods: The clinical and imaging data of 100 patients with thoracolumbar fractures admitted to our hospital from January 2021 to December 2023 were retrospectively analyzed. Two orthopedic surgeons, blinded to the patients' clinical outcomes, independently evaluated the cases using both scoring systems and provided treatment recommendations. Disagreements were resolved by a senior attending surgeon. Results: In 100 patients with thoracolumbar fractures, there was good agreement between mTLICS and TL AOSIS for surgical recommendations (P = 0.550, κ = 0.773). Among patients without neurological impairment, 24.6% of cases were recommended for surgery using mTLICS, while 19.2% were recommended using TL AOSIS; the agreement in this subgroup was P = 0.793, κ = 0.696. Among patients with neurological impairment, 90.7% of cases were recommended for surgery using mTLICS, while 81.4% were recommended using TL AOSIS; the agreement in this subgroup was P = 0.351, κ = 0.619. Both scoring systems showed good agreement in treatment decisions, with mTLICS demonstrating potential sensitivity in cases involving burst fractures with intervertebral disc injury. Conclusion: mTLICS and TL AOSIS are effective clinical decision-making tools and demonstrate good concordance in thoracolumbar fractures. for burst fractures with intervertebral disc involvement, mTLICS offers potential additional sensitivity.
Keywords: Thoracolumbar fracture, severity, Scoring, clinical application, modifiedtyping
Received: 08 Jul 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Zhang, Feng, Wu, Dou, Chen, Lin, Sun, Tang, Wu, Su, Dong and An. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhong-Cheng An
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