• Somayeh Hajiahmadi, Majid Rezvani, Saeid Fahimitabar, and Sina Rasti.
• Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
• World Neurosurg. 2023 Jan 1; 169: e73e82e73-e82.

ObjectiveTo compare the Thoracolumbar Injury Classification 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 Ligamentous Complex health was compared between intraoperative examinations and magnetic resonance imaging (MRI) reports.MethodsMRI 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 calculated the appropriate cut-off scores for the above systems over which surgical management was preferred. A P < 0.05 was considered significant.ResultsAll the approaches showed moderate agreements with the surgeon's opinion on therapeutic management (TLICS: κapproach1 = 0.557, κapproach2 =0.508; mTLICS: κapproach1 = 0.557, κapproach2 = 0.551; P < 0.001 for each κ). A score >3.5 best illustrated the indication for surgery in both systems. The radiology report agreed stronger with intraoperatively observed ligamentous health when suspicious cases on MRI were reported as injured (κTLICS = 0.830, κmTLICS = 0.704) rather than healthy (κTLICS = 0.620, κmTLICS = 0.620).ConclusionsThe 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 indicate a damaged ligament rather than a healthy one.Copyright © 2022 Elsevier Inc. All rights reserved.

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