Dao Quang Anh, Nguyen Van Son, Dang Van Quang, Tran Phuong Chinh, Le Dinh Thanh Son
Department of Diagnostic Imaging, Phu Tho Provincial General Hospital, Phu Tho, Vietnam.
Department of Neurosurgery, Phu Tho Provincial General Hospital, Phu Tho, Vietnam.
BMC Musculoskelet Disord. 2025 Sep 1;26(1):824. doi: 10.1186/s12891-025-09124-7.
Thoracolumbar injury classification systems such as TLICS and TL AOSIS are widely implemented but offer limited guidance in intermediate score ranges (TLICS = 3-4), where treatment decisions are often uncertain. The modified TLICS (mTLICS) was developed to address this gap by integrating MRI-derived quantitative parameters.
This retrospective study included 146 adults with MRI-confirmed thoracolumbar spine injuries (T1-L5) treated at Phu Tho Provincial General Hospital between April 2024 and May 2025. Inclusion required MRI within 7 days of trauma and complete clinical data, including ASIA grade, VAS score, and treatment modality. All cases were classified using TLICS, TL AOSIS, and mTLICS, and managed conservatively, minimally invasively, or surgically. Predictive performance for treatment allocation was assessed using ROC analysis, multinomial logistic regression, and decision curve analysis (DCA).
mTLICS showed the highest diagnostic accuracy across all treatment comparisons (AUC = 0.94-1.00), particularly in the intermediate-score group (TLICS = 3-4), with AUCs of 0.991 (conservative vs. surgical) and 0.965 (minimally invasive vs. surgical). Multinomial regression identified mTLICS as the sole independent predictor of treatment allocation (OR = 31.2-1338.4; p < 0.01), while TLICS and TL AOSIS were not statistically significant. DCA demonstrated the highest net clinical benefit for mTLICS, especially within the 0.3-0.6 threshold range.
The mTLICS demonstrated improved accuracy in stratifying thoracolumbar injuries across three treatment tiers and enhanced clarity in decision-making for intermediate cases. Its MRI-based components support personalized, image-guided management. Nonetheless, as clinicians at the study site were familiar with the mTLICS framework through prior academic exposure, potential incorporation bias cannot be entirely excluded. These findings should therefore be interpreted with caution, as mTLICS scores were calculated retrospectively after treatment completion and were not used prospectively to determine patient management, underscoring the need for prospective, multicenter validation to confirm its generalizability.
胸腰椎损伤分类系统，如胸腰椎损伤分类与严重程度评分（TLICS）和胸腰椎损伤严重程度评分（TL AOSIS）已被广泛应用，但在中间评分范围（TLICS = 3 - 4）内提供的指导有限，而在此范围内治疗决策往往不确定。改良的胸腰椎损伤分类与严重程度评分（mTLICS）旨在通过整合MRI衍生的定量参数来弥补这一差距。
这项回顾性研究纳入了2024年4月至2025年5月期间在富寿省综合医院接受治疗的146例经MRI确诊的胸腰椎脊柱损伤（T1 - L5）成人患者。纳入标准要求创伤后7天内进行MRI检查并提供完整的临床数据，包括美国脊髓损伤协会（ASIA）分级、视觉模拟评分（VAS）和治疗方式。所有病例均使用TLICS、TL AOSIS和mTLICS进行分类，并采用保守、微创或手术治疗。使用ROC分析、多项逻辑回归和决策曲线分析（DCA）评估治疗分配的预测性能。
在所有治疗比较中，mTLICS显示出最高的诊断准确性（AUC = 0.94 - 1.00），特别是在中间评分组（TLICS = 3 - 4）中，保守治疗与手术治疗的AUC为0.991，微创治疗与手术治疗的AUC为0.965。多项回归分析确定mTLICS是治疗分配的唯一独立预测因素（OR = 31.2 - 1338.4；p < 0.01），而TLICS和TL AOSIS无统计学意义。DCA显示mTLICS的净临床效益最高，尤其是在0.3 - 0.6阈值范围内。
mTLICS在对胸腰椎损伤进行三个治疗层级分层时显示出更高的准确性，并提高了中间病例决策的清晰度。其基于MRI的组成部分支持个性化的、图像引导的管理。尽管如此，由于研究地点的临床医生通过先前的学术接触熟悉mTLICS框架，潜在的纳入偏差不能完全排除。因此，这些发现应谨慎解释，因为mTLICS评分是在治疗完成后进行回顾性计算的，并未前瞻性地用于确定患者管理，这突出了进行前瞻性、多中心验证以确认其可推广性的必要性。
