Thoracolumbar spine fractures are not uncommon in clinical practice, and how to treat them has always been a clinical challenge. There is no uniform treatment protocol for the management of such fractures. The new AO thoracolumbar fracture staging simplifies the fracture and incorporates the patient’s neurological function and other medical comorbidities into the evaluation system, combining the advantages of the original AO staging and the TLICS staging, but it is still in the clinical promotion stage and the scoring system is not yet perfect. The TLICS score is still relied upon to guide the treatment of thoracolumbar fractures. The TLICS score requires the calculation of three variables: spinal fracture pattern (1 point for compression, 1 point for bursting, 3 points for displacement or rotation, and 4 points for dislocation), neurological status (0 points for intact, 2 points for nerve root injury, 2 points for complete spinal cord injury, and 3 points for incomplete spinal cord injury or cauda equina syndrome), and integrity of the posterior ligament complex (0 points for intact, 2 points for suspected injury, and 3 points for injury), with the three Surgery is recommended when the total score of the three variables exceeds 4 points (including 4 points), while conservative treatment is recommended when the score is less than 4 points. Despite this, it is rare for clinicians in China to follow the TLICS score completely for surgical and non-surgical treatment options, and cases of patients with one or two TLICS scores for surgical treatment are common. Figure 1: Female, high fall injury, L1 vertebral fracture with neurological integrity. a, Lateral L1 fracture with anterior loss of vertebral height; b, c, axial CT suggestive of vertebral burst fracture with plate fracture, TLICS score: 2 (morphology) + 0 (neurological function) + 0 (PLC), conservative treatment with thoracolumbar support for 6 months with good results; d-f, conservative treatment for 6 months After that, coronal and axial CT suggested bone bridge formation between T12-L1, healing of the fractured vertebral body, and resorption of the intravertebral canal occupancy; G, final follow-up, imaging suggested no localized retroflexion deformity. Figure 2: 30-year-old male, 7ft fall with neurological integrity. a, anteroposterior radiograph suggestive of T8 fracture; b, sagittal T image suggestive of intact PLC without intracanalicular occupancy; c, 1 year after injury, sagittal CT reconstruction; d, e, patient underwent posterior T5-T7, T9-10 pedicle screw fixation with intervertebral fusion due to the presence of severe persistent low back pain. The patient had only transient postoperative improvement in back pain, but continued to have low back pain in the back. Figure 3: 42-year-old male with a motorcycle fall, neurological integrity, and only mild neck pain. a, sagittal CT suggests T2 vertebral burst fracture with an intact articular synovial joint; b, axial CT suggests no intradiscal compression; c, sagittal T2 image MRI shows no spinal cord compression; d, sagittal MRI lipopressor image suggests PLC injury, TLICS score 2 + 2 + 0, total score 4 points; E, T1-3 fixation was performed. Some leading scholars believe that the TLICS score overemphasizes the integrity of the posterior ligamentous complex and ignores the importance of the anterior, middle column of the spine for spinal stability. The result is that non-operative treatment is recommended in cases with severe kyphosis but no neurological symptoms or posterior ligamentous injury. Although there is no documented evidence that kyphosis affects the functional prognosis of patients in the long term, kyphosis still has a potential impact on spinal profile and force line transfer. Recently, Brazilian scholar Andrei F. Joaquim conducted a study on the effectiveness of the TLICS score in guiding the treatment of thoracolumbar fractures, and the findings were published in the journal JNS:spine. The investigators selected 65 patients with spinal fractures seen at the institution from 2009 to 2012 and decided whether surgery was needed according to the TLICS score criteria: non-operative treatment for patients with scores less than 4 (37 patients in total, group 1) and surgery for patients with scores greater than 4 inclusive (28 patients in total, group 2), using the AIS score as the final prognostic evaluation index. In group 1, 28 patients with compression or burst fractures without neurological symptoms completed follow-up, with a mean age of 44.5 years and a follow-up period of 1-36 months, of whom 2 patients (TLICS score of 2) underwent surgery later for posterior back pain and mild localized kyphotic deformity, but the patients’ symptoms did not improve significantly; in group 2, all patients were followed up with a follow-up period of 1-18 months, of which 9 patients had a preoperative AIS grade E, 6 patients had a grade C, 1 patient had a grade B, and 12 patients had a grade A. At the end of post-treatment follow-up, 11 patients had a grade E, 5 patients had a grade D, and 12 patients had a grade A. No patient was found to have progressive worsening of neurological dysfunction during the later follow-up. Table 1: Distribution of different neurological status of patients before and after surgery according to the AIS classification This study is the first prospective clinical trial to evaluate whether the TLICS score is indeed valid in clinical practice. The findings support that the TLICS score can be used as a criterion for the need for surgical treatment in patients with spinal fractures. The shortcomings of this study are the small number of cases followed up, the short follow-up period, and the lack of scoring of patients’ daily function.