At the present stage, there are many typing and scoring systems for thoracolumbar spine fractures, such as AOspine’s newly introduced spine fracture typing system, TLICS scoring, and the earlier loading sharing scoring system, Dennis’ theory of three columns of the spine, etc. There are many typing systems, but each of them has more or less defects. In the past two years, the TLICS thoracolumbar fracture staging system has been increasingly used in domestic clinics, but its clinical utility has often been criticized by orthopedic surgeons. A case of failed conservative treatment of a thoracolumbar fracture of the spine based on the TLICS score is presented in the leading spine journal Euro Spine, and the TLICS score is reviewed in the context of previous reports in the literature. A recent publication by Krikham et al. in JBJS compared the long-term outcomes of conservative or surgical treatment of patients with stable thoracolumbar fractures without neurological symptoms, providing a great reference for the use of the TLICS score in clinical practice. The extremely long follow-up period of the study by Krikham et al. with a mean of 18 years (16-22 years) makes this article extremely informative. The authors followed 47 patients diagnosed with stable fractures of the thoracolumbar spine between 92-98, 24 of whom were treated surgically (19 patients received long-term follow-up) and 23 non-surgically (18 patients received long-term follow-up). The indicators of follow-up included the degree of kyphosis change, VAS score, ODI score, SF-36, Roland and Morris disability scores, and the corresponding patients’ work and health status and imaging-related data at the time of patient follow-up were recorded. The results of the study suggested that there was no significant difference in the progression of kyphosis between the two groups of patients with surgical and conservative treatment. Pain scores, ODI scores, and RM scores were significantly better with conservative treatment than with surgical treatment. For conservative treatment, about 83% of the patients could return to normal, while for surgical treatment, about 58% of the patients could return to work. Comparing the results of surgical and conservative treatment, it can be found that patients with stable fractures of the thoracolumbar segment of the spine have better results with conservative treatment than with surgical treatment. The confusion about the TLICS score can now be answered. The question that confuses clinicians is that patients with thoracolumbar burst fractures without neurological symptoms have a TLICS score of two and are recommended for nonoperative treatment, but most of these patients have had internal fixation in previous clinical practice. The TLICS score does not include consideration of kyphosis, and many clinicians are concerned that continued progression of kyphosis will lead to spinal dysfunction, so surgery is favored for patients with spinal fractures, especially those with very severe spinal vertebral fracture bursts, regardless of the TLICS score. The findings of this study, however, confirm to some extent the validity of the TLICS score in guiding clinical practice.