Pidd Kristina T, Sadauskas David, Tomatis Vanesa, Knight Ema J
School of Medicine, Flinders University, Adelaide, SA, Australia.
Department of Neurosurgery, Flinders Medical Centre, Adelaide, SA, Australia.
Global Spine J. 2025 May;15(4):2536-2546. doi: 10.1177/21925682241311303. Epub 2024 Dec 25.
Study DesignSystematic Literature Review.ObjectivesTo address whether TLICS or AOSpine is best used in clinical practice through assessment of interobserver and intraobserver reliability, agreement, and imaging modality performance.MethodsThis systematic literature review was reported in accordance with PRISMA 2020 guidelines. Articles were included based on meeting eligibility criteria: studies evaluating TLICS, AOSpine, and/or TL AOSIS through reliability, agreement, or imaging modality performance with adult patients (≥18) suffering from traumatic thoracolumbar fractures. Articles were acquired in April 2023 from Medline, CINAHL, and Scopus. Risk of bias was assessed through a modified COSMIN checklist. Tabulated results were separated by classification tool (TLICS or AOSpine/TL AOSIS) and reliability, agreement, or imaging modality results.ResultsTwenty-one studies were included in the final review. Interobserver and intraobserver AOSpine morphology reliability was on average superior to TLICS. Increased familiarity with the tool positively influenced both AOSpine and TLICS performance. For surgical treatment recommendation, AOSpine differentiated between stable and unstable burst fractures and guided clinician's more accurately than TLICS. Regarding conservative treatment, both TLICS and AOSpine reported similar clinical accuracy. TLICS performed significantly better when MRI was incorporated compared to CT alone. CT was sufficient as an imaging modality for AOSpine/TL AOSIS performance.ConclusionsAOSpine outperformed TLICS in surgical reliability, agreement and did not require additional MRI imaging to improve accuracy. Limitations of evidence include low quality of available studies and significant heterogeneity in patient and observer number. Future prospective multicentre research is recommended. This study was not funded and not registered on PROSPERO.
系统文献综述。
通过评估观察者间和观察者内的可靠性、一致性以及成像方式的性能，探讨在临床实践中TLICS或AOSpine哪种更适用。
本系统文献综述按照PRISMA 2020指南进行报告。纳入的文章需符合入选标准：对成年（≥18岁）创伤性胸腰椎骨折患者，通过可靠性、一致性或成像方式性能来评估TLICS、AOSpine和/或TL AOSIS。2023年4月从Medline、CINAHL和Scopus获取文章。通过修改后的COSMIN清单评估偏倚风险。将列表结果按分类工具（TLICS或AOSpine/TL AOSIS）以及可靠性、一致性或成像方式结果进行分类。
最终综述纳入了21项研究。AOSpine形态学的观察者间和观察者内可靠性平均优于TLICS。对工具的熟悉程度增加对AOSpine和TLICS的性能均有积极影响。对于手术治疗建议，AOSpine在区分稳定和不稳定爆裂骨折方面比TLICS更准确，能更好地指导临床医生。对于保守治疗，TLICS和AOSpine的临床准确性相似。与单独使用CT相比，纳入MRI时TLICS的表现明显更好。CT作为AOSpine/TL AOSIS性能的成像方式已足够。
AOSpine在手术可靠性和一致性方面优于TLICS，且无需额外的MRI成像来提高准确性。证据的局限性包括现有研究质量低以及患者和观察者数量存在显著异质性。建议未来进行前瞻性多中心研究。本研究未获资助，也未在PROSPERO上注册。
