Reliability and Validity of Thoracolumbar Injury Classification and Severity Score (TLICS)

STUDY DESIGN A new classification system for throacolumbar spine injury, Thoracolumbar Injury Classification and Severity Score (TLICS) was evaluated retrospectively. PURPOSE To evaluate intrarater and interrater reliability of newly proposed TLICS schemes and to estimate validity of TLICS's final treatment recommendation. OVERVIEW OF LITERATURE Despite numerous literature about thoracolumbar spine injury classifications, there is no consensus regarding the optimal system. METHODS Using plain radiographs, computed tomography scanning, magnetic resonance imaging, and medical records, 3 clssifiers, consisting of 2 spine surgeons and 1 senior orthopaedic surgery resident, reviewed 114 clinical thoracolumbar spine injury cases retrospectively to classify and calculate injury severity score according to TLICS. This process were repeated on 4 weeks intervals and the scores were then compared with type of treatment that patient ultimately received. RESULTS The intrarater reliability of TLICS was substantial agreement on total score and injury morphology, almost perfect agreement on integrity of the posterior ligament complex (PLC) and neurologic status. The interrater reliability was substantial agreement on injury morphology and integrity of the PLC, moderate agreement on total score, almost perfect agreement on neurologic status. The TLICS schems exhibited satisfactory overall validity in terms of clinical decision making. CONCLUSIONS The TLICS was demonstrated acceptable intrarater and interrater reliability and satisfactory validity in terms of treatment recommendation.