Study Design Systematic Literature Review. Objectives To address whether TLICS or AOSpine is best used in clinical practice through assessment of interobserver and intraobserver reliability, agreement, and imaging modality performance. Methods This systematic literature review was reported in accordance with PRISMA 2020 guidelines. Articles were included based on meeting eligibility criteria: studies evaluating TLICS, AOSpine, and/or TL AOSIS through reliability, agreement, or imaging modality performance with adult patients (≥18) suffering from traumatic thoracolumbar fractures. Articles were acquired in April 2023 from Medline, CINAHL, and Scopus. Risk of bias was assessed through a modified COSMIN checklist. Tabulated results were separated by classification tool (TLICS or AOSpine/TL AOSIS) and reliability, agreement, or imaging modality results. Results Twenty-one studies were included in the final review. Interobserver and intraobserver AOSpine morphology reliability was on average superior to TLICS. Increased familiarity with the tool positively influenced both AOSpine and TLICS performance. For surgical treatment recommendation, AOSpine differentiated between stable and unstable burst fractures and guided clinician’s more accurately than TLICS. Regarding conservative treatment, both TLICS and AOSpine reported similar clinical accuracy. TLICS performed significantly better when MRI was incorporated compared to CT alone. CT was sufficient as an imaging modality for AOSpine/TL AOSIS performance. Conclusions AOSpine outperformed TLICS in surgical reliability, agreement and did not require additional MRI imaging to improve accuracy. Limitations of evidence include low quality of available studies and significant heterogeneity in patient and observer number. Future prospective multicentre research is recommended. This study was not funded and not registered on PROSPERO.
