Comparative analysis of two modified TLICS systems in guiding surgical decision-making for thoracolumbar fractures.

Objective: 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. Methods: 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 "gold standard," 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 Results: All three scoring systems demonstrated excellent inter-observer agreement, with NmTLICS ( Conclusion: 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.