{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:49:36Z","timestamp":1782452976734,"version":"3.54.5"},"reference-count":25,"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 compare the Novel Modified Thoracolumbar Injury Classification System (NmTLICS) and the China-modified Thoracolumbar Injury Classification System (CN-mTLICS) in guiding surgical decision-making for thoracolumbar fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed the complete imaging data of 101 patients with single-level thoracolumbar fractures admitted between January 2021 and December 2023. Two independent observers scored the patients using the traditional TLICS, NmTLICS, and CN-mTLICS systems. Using the actual clinical treatment decision as the \u201cgold standard,\u201d inter-observer agreement was assessed with Cohen's Kappa coefficient. Discrimination was evaluated by the area under the ROC curve (AUC) with pairwise DeLong comparison; classification accuracy among the three related systems was compared with a global Cochran's\n                      <jats:italic>Q<\/jats:italic>\n                      -test followed by\n                      <jats:italic>post hoc<\/jats:italic>\n                      McNemar tests with Bonferroni correction; and model calibration and clinical utility were assessed by calibration analysis and decision curve analysis. Discrepant cases between the two modified systems were further analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All three scoring systems demonstrated excellent inter-observer agreement, with NmTLICS (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.896) and CN-mTLICS (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.866) outperforming traditional TLICS (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.849). Regarding diagnostic efficacy, both NmTLICS and CN-mTLICS showed significantly higher sensitivity and NPV than traditional TLICS (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01). They successfully identified 17 and 16 patients, respectively, who were recommended for conservative treatment by TLICS but actually required surgery. There was no statistically significant difference in specificity compared with TLICS (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). Discrepancy analysis revealed significant clinical complementarity between the two modified systems: NmTLICS detected 6 cases of severe vertebral collapse (&amp;gt;50%) missed by CN-mTLICS, while CN-mTLICS identified 5 cases of severe intervertebral disc injury missed by NmTLICS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both NmTLICS and CN-mTLICS reduced the under-triage of severe burst fractures by TLICS, mainly through higher sensitivity and negative predictive value without a significant loss of specificity, and they address complementary dimensions (fracture morphology and intervertebral disc injury, respectively). As these are exploratory single-center findings based on treatment decisions rather than long-term outcomes, prospective multicenter validation is needed before routine clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1855503","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:43:48Z","timestamp":1782452628000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative analysis of two modified TLICS systems in guiding surgical decision-making for thoracolumbar fractures"],"prefix":"10.3389","volume":"13","author":[{"given":"Han","family":"Zhang","sequence":"first","affiliation":[{"name":"The Second School of Clinical Medicine of 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 of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wu","sequence":"additional","affiliation":[{"name":"The Second School of Clinical Medicine of 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 of 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 of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huibin","family":"Luo","sequence":"additional","affiliation":[{"name":"Wangjing Hospital, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binbin","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics II, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics II, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics II, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongcheng","family":"An","sequence":"additional","affiliation":[{"name":"Spine Center, 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 II, The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"B1","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":"B2","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":"B3","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1186\/s13018-020-02044-3","article-title":"Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture","volume":"15","author":"Alimohammadi","year":"2020","journal-title":"J Orthop Surg Res"},{"key":"B4","doi-asserted-by":"publisher","first-page":"21925682251414046","DOI":"10.1177\/21925682251414046","article-title":"Adverse events and treatment failure in patients with thoracolumbar burst fractures without neurological deficit: a sub analysis from prospective multicentric study","author":"Camino Willhuber","year":"2025","journal-title":"Global Spine J"},{"key":"B5","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":"B6","doi-asserted-by":"publisher","first-page":"41s","DOI":"10.1177\/21925682231196452","article-title":"The influence of comminution and posterior ligamentous Complex integrity on treatment decision making in thoracolumbar burst fractures without neurologic deficit?","volume":"14","author":"Aly","year":"2024","journal-title":"Global Spine J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1038\/s41598-025-85543-9","article-title":"Unilateral biportal endoscopic decompression combined with percutaneous pedicle screw fixation offers new treatment option for thoracolumbar burst fractures with secondary spinal stenosis","volume":"15","author":"Bai","year":"2025","journal-title":"Sci Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1227\/neu.0000000000003055","article-title":"Validation and comparison of common thoracolumbar injury classification treatment algorithms and a novel modification","volume":"96","author":"Withrow","year":"2025","journal-title":"Neurosurgery"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.1016\/j.spinee.2021.04.016","article-title":"Intervertebral disc degeneration relates to biomechanical changes of spinal ligaments","volume":"21","author":"Cornaz","year":"2021","journal-title":"Spine J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1186\/s13018-023-03958-4","article-title":"The difference and clinical application of modified thoracolumbar fracture classification scoring system in guiding clinical treatment","volume":"18","author":"Wenjie","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B11","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":"B12","doi-asserted-by":"publisher","first-page":"333","DOI":"10.31616\/asj.2020.0027","article-title":"Evaluation of diagnostic accuracy of magnetic resonance imaging in posterior ligamentum Complex injury of thoracolumbar spine","volume":"15","author":"Mehta","year":"2021","journal-title":"Asian Spine J"},{"key":"B13","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":"AJR Am J Roentgenol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1089\/neu.2020.7473","article-title":"Characterizing natural recovery after traumatic spinal cord injury","volume":"38","author":"Kirshblum","year":"2021","journal-title":"J Neurotrauma"},{"key":"B15","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":"B16","doi-asserted-by":"publisher","first-page":"e43762","DOI":"10.7759\/cureus.43762","article-title":"Evaluation of the thoracolumbar injury classification and severity (TLICS) score over a two-year period at a level one trauma center","volume":"15","author":"Gonzales-Portillo","year":"2023","journal-title":"Cureus"},{"key":"B17","doi-asserted-by":"publisher","first-page":"19494","DOI":"10.1038\/s41598-020-76473-9","article-title":"Clinical relevance and validity of TLICS system for thoracolumbar spine injury","volume":"10","author":"Park","year":"2020","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1760","DOI":"10.1016\/j.spinee.2013.03.014","article-title":"Retrospective evaluation of the validity of the thoracolumbar injury classification system in 458 consecutively treated patients","volume":"13","author":"Joaquim","year":"2013","journal-title":"Spine J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"E330","DOI":"10.1097\/BRS.0000000000005156","article-title":"Enhancing diagnostic accuracy of fresh vertebral compression fractures with deep learning models","volume":"50","author":"Li","year":"2025","journal-title":"Spine. (Phila Pa 1976)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1007\/s00256-021-03846-0","article-title":"Traumatic vertebra and endplate fractures promote adjacent disc degeneration: evidence from a clinical MR follow-up study","volume":"51","author":"Lu","year":"2022","journal-title":"Skeletal Radiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"256","DOI":"10.4103\/2229-5151.170840","article-title":"Complications during intrahospital transport of critically ill patients: focus on risk identification and prevention","volume":"5","author":"Knight","year":"2015","journal-title":"Int J Crit Illn Inj Sci"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e887","DOI":"10.1097\/BPO.0000000000002765","article-title":"Imaging outcomes of MRI after CT in pediatric spinal trauma: a single-center experience","volume":"44","author":"Sir\u00e9n","year":"2024","journal-title":"J Pediatr Orthop"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.3390\/cells12172161","article-title":"A review: methodologies to promote the differentiation of mesenchymal stem cells for the regeneration of intervertebral disc cells following intervertebral disc degeneration","volume":"12","author":"Ohnishi","year":"2023","journal-title":"Cells"},{"key":"B24","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 (Phila Pa 1976)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1055\/s-0035-1549034","article-title":"A worldwide analysis of the reliability and perceived importance of an injury to the posterior ligamentous Complex in AO type A fractures","volume":"5","author":"Schroeder","year":"2015","journal-title":"Global Spine J"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1855503\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:43:49Z","timestamp":1782452629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1855503\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":25,"alternative-id":["10.3389\/fsurg.2026.1855503"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1855503","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"article-number":"1855503"}}