Park Hee Jin, Lee So Yeon, Park Noh Hyuck, Shin Hun Gyu, Chung Eun Chul, Rho Myung Ho, Kim Mi Sung, Kwon Heon Ju
Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
Department of Radiology, Myongji Hospital, Seoul, Republic of Korea
Acta Radiol. 2016 Jan;57(1):74-81. doi: 10.1177/0284185115580487. Epub 2015 Apr 8.
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.
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.
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.
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.
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.
胸腰段损伤分类及严重程度评分（TLICS）对于评估后韧带复合体损伤的可靠性欠佳，即便由专家进行评分亦是如此。将每一例压缩骨折或爆裂骨折同等评分并不合理，因为压缩骨折和爆裂骨折在严重程度上存在很大差异。
提出改良的胸腰段损伤分类及严重程度评分（mTLICS），并通过测量放射科医生使用这两种系统确定的评分与实际实施的治疗程序之间的一致性，来评估mTLICS系统的性能。
我们回顾性评估了134例急性胸腰椎创伤患者，这些患者在接受磁共振成像（MRI）后，使用新的mTLICS和传统的TLICS系统进行评估。使用kappa统计分析TLICS和mTLICS评分的观察者间一致性。采用非参数相关分析来确定各评分与手术干预之间的相关性（R）。
mTLICS系统显示出比TLICS略高的相关性（Rs，TLICS为0.592和0.613，而mTLICS为0.628和0.639）。如果将总分4视为手术禁忌指征，mTLICS的敏感性显著高于TLICS；如果将总分4视为手术指征，mTLICS的特异性显著高于TLICS。
mTLICS评分纠正了TLICS系统中导致放射学诊断标准不明确的缺陷。mTLICS是一种比TLICS更适合准确预测手术治疗的评分系统，尤其对于形态学损伤。
