Journal List > J Korean Soc Spine Surg > v.19(1) > 1075983

J Korean Soc Spine Surg. 2012 Mar;19(1):8-15. Korean.
Published online March 31, 2012.
© Copyright 2012 Korean Society of Spine Surgery
Comparison of TLICS & McAfee Classification in Thoracolumbar Injuries
Woo Chul Kim, M.D., Kyu Yeol Lee, M.D.,* Jin Hun Kang, M.D., and Young Hoon Lim, M.D.*
Department of Orthopedic Surgery, Boomin Hospital, Korea.
*Department of Orthopedic Surgery, College of Medicine, Dong-A University, Korea.
Department of Orthopaedic Surgery, Busan Centum Hospital, Korea.

Corresponding author: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. TEL: 82.51-240-2867, FAX: 82.51-243-9764, Email:
Received June 26, 2011; Revised December 05, 2011; Accepted December 21, 2011.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Study Design

A retrospective study.


We assessed the intraobserver and interobserver reliability of TLICS classification in the thoracolumbar injuries, which had been evaluated in our hospital. It was compared with that of the older, McAfee classification and discussed for clinical validation.

Summary of Literature Review

Among the numerous literatures regarding the thoracolumbar injury, there is no consensus on the most useful classification, and there is nothing comparing the McAfee classification with the TLICS classification.

Materials and Methods

Among the 230 patients that were treated with conservative care or operation from January 1, 2005 to January 1, 2010 in our hospital, 185 patients with initial CT and MRI images were assessed. Five orthopedic surgeons reviewed histories, plain film, CT and MRI of the 185 thoracolumbar injury cases, respectively. Each case was classified and scored according to the McAfee classification and the TLICS classification. The case assessment was recorded and the orthopedic surgeons repeated the assessment 1 month later. Intraobserver and interobserver reliability were assessed by statistical analysis. The actual management of each case was compared with the treatment recommended by TLICS classification to calculate the validity of the indexes.


Intraobserver and interobserver reliability in TLICS were higher than those in the McAfee classification. Agreement of the TLICS classification for treatment recommendation was 81.7%, comparing with the actual management of previous McAfee classification. Validity indexes were satisfactory in therapeutic decision making, especially specificity.


TLICS classification has a relative high K-value, when compared with that of the McAfee classification for intraobserver and interobserver reliability. Through clinical studies, including prospective observational analysis, TLICS classification can be applied and adjusted more adequately.

Keywords: Thoracolumbar spine; spinal injury; McAfee classification; TLICS classification


Fig. 1
A 72-year-old male with back pain (A) Preoperative X-ray (B) Preoperative CT (C) Preoperative MRI with T1 and T2 sagital view (D) Postoperative X-ray showing open reduction with instrumented PLF. In McAfee classification, it was unstable bursting fracture. In TLICS classification, burst fractrure(2 point), posterior ligament complex injury(3 point) and neurologically intact state. Total score was 5 point. The therapeutic decision of McAfee classification was coincided with TLICS classification.
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Fig. 2
A 42-year-old male with back pain (A) Preoperative X-ray (B) Preoperative CT (C) Preoperative MRI with T1 and T2 sagital view (D) Postoperative X-ray showing open reduction with instrumented PLF. In McAfee classification, it was unstable bursting fracture. In TLICS classification, burst fractrure was 2 point, but posterior ligament complex and neurologic state were intact. Total score was 2 point. But, the patient was treated with surgery due to multiple trauma and early rehabilitation.
Click for larger image


Table 1
Intraobserver statistics of McAfee classification and TLICS classificatio
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Table 2
Interobserver statistics of McAfee classification and TLICS classification
Click for larger image

Table 3
Validity data of TLICS classification
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