{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:51:37Z","timestamp":1782449497638,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the reliability and reproducibility of the modified Thoracolumbar Injury Classification and Severity Score (mTLICS) and the Thoracolumbar AO Spine Injury Score (TL AOSIS) in guiding surgical decision-making for thoracolumbar fractures, and to investigate factors associated with observer agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 100 thoracolumbar injury patients treated at the Second Affiliated Hospital of Zhejiang Chinese Medical University from January 2021 to December 2023, all with complete preoperative imaging data. The cohort included 64 males and 36 females, aged 25\u201355 years (mean 41.3\u2009\u00b1\u20096.9 years). Six evaluators independently assessed the anonymized cases on two occasions separated by a 4-week interval. Weighted Cohen's kappa coefficients were used to evaluate interobserver reliability and intraobserver reproducibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For TL AOSIS, interobserver\/intraobserver kappa values 0.706\/0.687 for fracture morphology, 0.906\/0.942 for neurological status, 0.869\/0.879 for tension band injury, and 0.736\/0.732 for surgical recommendation, respectively. For mTLICS, interobserver\/intraobserver kappa values were 0.773\/0.763 for fracture morphology, 0.878\/0.894 for neurological status, 0.716\/0.721 for tension band injury, 0.837\/0.845 for disc injury, and 0.702\/0.685 for surgical recommendation, respectively. Significant differences (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05) were observed between systems in fracture morphology and tension band injury assessments, while no significant differences (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05) were found in neurological status evaluations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both TL AOSIS and mTLICS demonstrate good reliability and reproducibility in guiding surgical decision-making for thoracolumbar fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1828906","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:39:28Z","timestamp":1782448768000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reliability and reproducibility of the modified thoracolumbar injury classification and severity score and the thoracolumbar AO spine injury score for guiding surgical decision-making in thoracolumbar fractures"],"prefix":"10.3389","volume":"13","author":[{"given":"Bing","family":"Wu","sequence":"first","affiliation":[{"name":"The Second School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiale","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Second School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Second School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junwei","family":"Feng","sequence":"additional","affiliation":[{"name":"The Second School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayi","family":"Dou","sequence":"additional","affiliation":[{"name":"The Second School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binbin","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianguo","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weina","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongcheng","family":"An","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingyuan","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1038\/s41394-020-0315-4","article-title":"Fracture-dislocation of the thoracolumbar spine without neurological deficit: a report of two cases and literature review","volume":"6","author":"Kumar","year":"2020","journal-title":"Spinal Cord Ser Cases"},{"key":"B2","doi-asserted-by":"publisher","first-page":"704","DOI":"10.14245\/ns.2142418.209","article-title":"Incidence and epidemiology of thoracolumbar spine fractures: wfns spine committee recommendations","volume":"18","author":"Zileli","year":"2021","journal-title":"Neurospine"},{"key":"B3","doi-asserted-by":"publisher","first-page":"656","DOI":"10.14245\/ns.2142650.325","article-title":"Classification and radiological diagnosis of thoracolumbar spine fractures: wFNS spine committee recommendations","volume":"18","author":"Bajamal","year":"2021","journal-title":"Neurospine"},{"key":"B4","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1007\/BF02221591","article-title":"A comprehensive classification of thoracic and lumbar injuries","volume":"3","author":"Magerl","year":"1994","journal-title":"Eur Spine J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1007\/s001320050397","article-title":"Inter-Observer reliability in the classification of thoraco-lumbar spinal injuries","volume":"28","author":"Blauth","year":"1999","journal-title":"Orthopade"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e493","DOI":"10.1016\/j.wneu.2020.02.013","article-title":"Is the thoracolumbar aospine injury score superior to the thoracolumbar injury classification and severity score for guiding the treatment strategy of thoracolumbar spine injuries?","volume":"137","author":"An","year":"2020","journal-title":"World Neurosurg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2255","DOI":"10.1007\/s00586-014-3312-0","article-title":"Progressive kyphotic deformity in comminuted burst fractures treated non-operatively: the achilles tendon of the thoracolumbar injury classification and severity score (tlics)","volume":"23","author":"Mattei","year":"2014","journal-title":"Eur Spine J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.22203\/eCM.v025a01","article-title":"Challenges and strategies in the repair of ruptured annulus fibrosus","volume":"25","author":"Guterl","year":"2013","journal-title":"Eur Cell Mater"},{"key":"B9","doi-asserted-by":"publisher","first-page":"E317","DOI":"10.1097\/bsd.0000000000000656","article-title":"Outcomes in thoracolumbar burst fractures with a thoracolumbar injury classification score (tlics) of 4 treated with surgery versus initial conservative management","volume":"31","author":"Nataraj","year":"2018","journal-title":"Clin Spine Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1054031","DOI":"10.3389\/fsurg.2022.1054031","article-title":"Reliability and repeatability of a modified thoracolumbar spine injury classification scoring system","volume":"9","author":"Lu","year":"2022","journal-title":"Front Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1097\/BRS.0b013e31827934e4","article-title":"Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous Complex of the thoracolumbar spine","volume":"38","author":"Pizones","year":"2013","journal-title":"Spine"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1097\/00007632-200008150-00012","article-title":"Reliability of magnetic resonance imaging in detecting posterior ligament Complex injury in thoracolumbar spinal fractures","volume":"25","author":"Lee","year":"2000","journal-title":"Spine"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1097\/BRS.0b013e3182a8a381","article-title":"Aospine thoracolumbar spine injury classification system: fracture description, neurological Status, and key modifiers","volume":"38","author":"Vaccaro","year":"2013","journal-title":"Spine"},{"key":"B14","doi-asserted-by":"publisher","first-page":"618","DOI":"10.2214\/AJR.12.8748","article-title":"A clinically useful classification of traumatic intervertebral disk lesions","volume":"200","author":"Sander","year":"2013","journal-title":"Am J Roentgenol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1055\/s-0035-1563610","article-title":"The thoracolumbar aospine injury score","volume":"6","author":"Kepler","year":"2016","journal-title":"Global Spine J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1177\/2192568218806847","article-title":"Reliability and validity of the aospine thoracolumbar injury classification system: a systematic review","volume":"9","author":"Abedi","year":"2019","journal-title":"Global Spine J"},{"key":"B17","doi-asserted-by":"publisher","first-page":"19","DOI":"10.21037\/mhealth-24-50","article-title":"Tele-exercise in individuals with spinal cord injury: a systematic review","volume":"11","author":"Gomes Costa","year":"2025","journal-title":"Mhealth"},{"key":"B18","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1089\/neur.2023.0035","article-title":"Perspectives on data sharing in persons with spinal cord injury","volume":"4","author":"Warner","year":"2023","journal-title":"Neurotrauma Rep"},{"key":"B19","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1007\/s12178-023-09873-9","article-title":"The impact of spine pathology on posterior ligamentous Complex structure and function","volume":"16","author":"Anderson","year":"2023","journal-title":"Curr Rev Musculoskelet Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e32721","DOI":"10.1097\/MD.0000000000032721","article-title":"Imaging parameters and clinical significance of posterior ligament complex injury in thoracolumbar fracture","volume":"102","author":"Guo","year":"2023","journal-title":"Medicine"},{"key":"B21","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1007\/s00586-012-2602-7","article-title":"The precision, accuracy and validity of detecting posterior ligamentous Complex injuries of the thoracic and lumbar spine: a critical appraisal of the literature","volume":"22","author":"van Middendorp","year":"2013","journal-title":"Eur Spine J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1186\/s12891-025-09124-7","article-title":"Diagnostic accuracy and clinical utility of mtlics versus tlics and tl aosis in stratifying three-tier treatment for thoracolumbar injuries: focus on intermediate score range","volume":"26","author":"Dao","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"B23","doi-asserted-by":"publisher","first-page":"17S","DOI":"10.1177\/21925682231202371","article-title":"Interobserver reliability in the classification of thoracolumbar fractures using the ao spine tl injury classification system among 22 clinical experts in spine trauma care","volume":"14","author":"Canseco","year":"2024","journal-title":"Global Spine J"},{"key":"B24","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1111\/j.1533-2500.2007.00171.x","article-title":"Intervertebral disc: anatomy-physiology-pathophysiology-treatment","volume":"8","author":"Raj","year":"2008","journal-title":"Pain Pract"},{"key":"B25","doi-asserted-by":"publisher","first-page":"297","DOI":"10.6061\/clinics\/2016(06)02","article-title":"A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures","volume":"71","author":"Su","year":"2016","journal-title":"Clinics"},{"key":"B26","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.injury.2017.12.011","article-title":"Prediction of mri findings including disc injury and posterior ligamentous Complex injury in neurologically intact thoracolumbar burst fractures by the parameters of vertebral body damage on Ct scan","volume":"49","author":"Mi","year":"2018","journal-title":"Injury"},{"key":"B27","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.jspd.2017.07.001","article-title":"Reciprocal changes in sagittal alignment with operative treatment of adolescent scheuermann kyphosis-prospective evaluation of 96 patients","volume":"6","author":"Lonner","year":"2018","journal-title":"Spine Deform"},{"key":"B28","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s40610-018-0105-y","article-title":"Contribution of the endplates to disc degeneration","volume":"4","author":"Fields","year":"2018","journal-title":"Curr Mol Biol Rep"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e11442","DOI":"10.1097\/MD.0000000000011442","article-title":"Magnetic resonance imaging evaluation of intervertebral disc injuries can predict kyphotic deformity after posterior fixation of unstable thoracolumbar spine injuries","volume":"97","author":"Kanezaki","year":"2018","journal-title":"Medicine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"174","DOI":"10.14444\/8427","article-title":"Radiographic outcomes following various treatment options of thoracolumbar burst fractures","volume":"17","author":"Parmar","year":"2023","journal-title":"Int J Spine Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2184","DOI":"10.1007\/s00586-013-2738-0","article-title":"Ao spine injury classification system: a revision proposal for the thoracic and lumbar spine","volume":"22","author":"Reinhold","year":"2013","journal-title":"Eur Spine J"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1828906\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:39:32Z","timestamp":1782448772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1828906\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":31,"alternative-id":["10.3389\/fsurg.2026.1828906"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1828906","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"article-number":"1828906"}}