title: Modified thoracolumbar injury classification and severity score (TLICS) and its clinical usefulness.
abstract: BACKGROUND
  Thoracolumbar injury classification and severity score (TLICS) is not very reliable for assessment of injury to the posterior ligament complex, even when scored by experts. It is not reasonable to score every compression fracture or burst fracture the same as there is great variety in the severity of compression fractures and burst fractures.
  
  
  OBJECTIVE
  To propose a modified TLICS (mTLICS) and evaluate the performance of the mTLICS system by measuring the agreement between scores determined by radiologists using both systems and actual treatment procedure delivered.
  
  
  METHODS
  We retrospectively evaluated 134 patients with acute lumbar and thoracic spinal trauma after undergoing magnetic resonance imaging (MRI) using new mTLICS and conventional TLICS system. Inter-observer agreements of TLICS and mTLICS scores were analyzed using the kappa statistic. Nonparametric correlation analysis was used to determine correlation (R) among each score and the surgical intervention.
  
  
  RESULTS
  The mTLICS system showed slightly higher correlation than TLICS (Rs, TLICS, 0.592 and 0.613 vs. mTLICS, 0.628 and 0.639). If we consider a total maximal score of 4 to be a negative surgical indication, mTLICS showed significantly higher sensitivities than TLICS, and if we consider a total minimal score of 4 to be a positive surgical indication, mTLICS showed significantly higher specificities than TLICS.
  
  
  CONCLUSIONS
  The mTLICS score corrects deficiencies in the TLICS system that lead to ambiguity in the radiological diagnostic criteria. mTLICS is a more suitable scoring system than TLICS for predicting surgical management accurately, especially for morphological injuries.
authors: Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors: Hee Jin
authors: HJ
authors: Park
authors: Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors: So Yeon
authors: SY
authors: Lee
authors: Department of Radiology, Myongji Hospital, Seoul, Republic of Korea radiology11@hanmail.net.
authors: Noh Hyuck
authors: NH
authors: Park
authors: Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors: Hun Gyu
authors: HG
authors: Shin
authors: Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors: Eun Chul
authors: EC
authors: Chung
authors: Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors: Myung Ho
authors: MH
authors: Rho
authors: Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors: Mi Sung
authors: MS
authors: Kim
authors: Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
authors: Heon Ju
authors: HJ
authors: Kwon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000145:classification*; D013904:Thoracic Vertebrae / Q000293:injuries*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: Magnetic resonance imaging (MRI); classification; compression; lumbar vertebrae; thoracic vertebrae