Reliability of the thoracolumbar injury classification and severity score compared with the McAfee classification among young neurosurgeons

Objective: The reliability of the thoracolumbar injury classification and severity (TLICS) score is well established; however, its reliability among young neurosurgeons in particular has not been investigated. This study was designed to identify intra-and inter-observer differences between the TLICS system and the McAfee classification among young neurosurgeons, with the goal of facilitating communication between physicians and treatment decision-making for patients with thoracolumbar injuries. Methods: Six young neurosurgeons reviewed thoracolumbar spinal fracture patients between January 2016 and October 2020 and analyzed thoracolumbar fractures according to the 2 classification systems. The intra- and inter-observer reliability of the TLICS and the McAfee scale was assessed with the Cohen and Fleiss kappa tests. Results: The intra-observer kappa value for the TLICS exhibited excellent reliability ( κ =0.85) compared to the McAfee classification ( κ =0.79). The inter-observer kappa values for each category of the TLICS were 0.69 (morphology), 0.93 (neurologic status), 0.74 (posterior ligamentous complex), and 0.72 (total score). The kappa value of the McAfee classification was lower ( κ =0.52). Conclusion: The TLICS system showed higher reliability than the McAfee classification. The TLICS score showed more consistent results for thoracolumbar spinal fractures and may thus serve as a guideline for young neurosurgeons in treating patients with thoracolumbar fractures.