MODIFIED TLICS SCORE (MTLICS) FOR DIAGNOSIS AND TREATMENT GUIDANCE IN THORACOLUMBAR SPINE INJURIES: A STUDY FROM PHU THO PROVINCIAL GENERAL HOSPITAL

Abstract

Introduction: This study aimed to evaluate the value of the modified Thoracolumbar Injury Classification and Severity Score (mTLICS) in diagnosing and guiding the treatment of thoracolumbar spine injuries at Phu Tho Provincial General Hospital. It also compared mTLICS with TLICS and TL AOSIS systems in predicting surgical and conservative treatment decisions. Subjects and Methods: A retrospective study was conducted on 41 patients with thoracolumbar spine injuries from January to April 2025. All patients underwent a 3.0 Tesla MRI. Their injuries were classified using TLICS, TL AOSIS and mTLICS. The classification results were compared with treatment decisions to assess sensitivity, specificity, and accuracy. Results: mTLICS showed superior diagnostic performance with 89% sensitivity, 100% specificity, and 93% accuracy (based on the second reader). Inter-rater agreement was moderate to substantial (Kappa = 0.708 for fracture morphology and 0.8 for posterior ligamentous injury). The mTLICS also highly correlated with surgical decision-making (r = 0.779 and 0.755). Notably, it achieved the highest area under the ROC curve (AUROC: 0.939–0.95), compared to TLICS (0.855–0.874) and TL AOSIS (0.802–0.843). At a cutoff score >3, mTLICS reached 92–100% sensitivity and 81.25% specificity. Conclusion: mTLICS is a reliable and accurate classification system for thoracolumbar injuries, offering better predictive value than TLICS and TL AOSIS. Its implementation may enhance decision-making and treatment outcomes, especially in provincial hospitals.