Rahul Kaul1, Harvinder Singh Chhabra2, Alexander R Vaccaro3, Rainer Abel4, Sagun Tuli5, Ajoy Prasad Shetty6, Kali Dutta Das7, Bibhudendu Mohapatra7, Ankur Nanda7, Gururaj M Sangondimath7, Murari Lal Bansal7, Nishit Patel7. 1. Department of Orthopedics, Flt. Lt. Rajan Dhal, Fortis Hospital, Vasant Kunj, New Delhi, India. 2. Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India. drhschhabra@isiconline.org. 3. Department of Orthopaedic Surgery, Delaware Valley Spinal Cord Injury Center, Rothman Institute, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA. 4. Klinik für Querschnittgelähmte, Orthopädie und Rheumatologie, Klinik Hohe Warte, Klinikum Bayreuth GmbH, Bayreuth, Germany. 5. Florida Spinal Surgery Center, Miami, FL, USA. 6. Division of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, Coimbatore, India. 7. Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, India.
Abstract
PURPOSE: The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries. METHODS: Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation. RESULTS: Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems. CONCLUSIONS: Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.
PURPOSE: The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries. METHODS: Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation. RESULTS: Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems. CONCLUSIONS: Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.
Authors: Jeffrey A Rihn; Nuo Yang; Charles Fisher; Davor Saravanja; Harvey Smith; William B Morrison; James Harrop; Alexander R Vacaro Journal: J Neurosurg Spine Date: 2010-04
Authors: Alexander R Vaccaro; Eli M Baron; James Sanfilippo; Sidney Jacoby; Jacob Steuve; Eric Grossman; Matthew DiPaola; Paul Ranier; Luke Austin; Ray Ropiak; Michael Ciminello; Chuka Okafor; Matthew Eichenbaum; Venkat Rapuri; Eric Smith; Fabio Orozco; Peter Ugolini; Mark Fletcher; Jonathan Minnich; Gregory Goldberg; Jared Wilsey; Joon Y Lee; Moe R Lim; Anthony Burns; Ralph Marino; Christian DiPaola; Laura Zeiller; Steven C Zeiler; James Harrop; D Greg Anderson; Todd J Albert; Alan S Hilibrand Journal: Spine (Phila Pa 1976) Date: 2006-05-15 Impact factor: 3.468
Authors: Christopher M Bono; Alexander R Vaccaro; R J Hurlbert; Paul Arnold; F C Oner; James Harrop; Neel Anand Journal: J Orthop Trauma Date: 2006-09 Impact factor: 2.512
Authors: Timothy A Moore; Richard J Bransford; John C France; James Anderson; Michael P Steinmetz; Daniel Lubelski; Paul A Anderson Journal: Spine (Phila Pa 1976) Date: 2014-08-01 Impact factor: 3.468
Authors: Y Raja Rampersaud; Charles Fisher; Jared Wilsey; Paul Arnold; Neel Anand; Chris M Bono; Andrew T Dailey; Marcel Dvorak; Michael G Fehlings; James S Harrop; F C Oner; Alexander R Vaccaro Journal: J Spinal Disord Tech Date: 2006-10
Authors: Alexander R Vaccaro; Steven C Zeiller; R John Hulbert; Paul A Anderson; Mitchel Harris; Rune Hedlund; James Harrop; Marcel Dvorak; Kirkham Wood; Michael G Fehlings; Charles Fisher; Ronald A Lehman; D Greg Anderson; Christopher M Bono; Timothy Kuklo; F C Oner Journal: J Spinal Disord Tech Date: 2005-06
Authors: F C Oner; L M P Ramos; R K J Simmermacher; P T D Kingma; C H Diekerhof; W J A Dhert; A J Verbout Journal: Eur Spine J Date: 2002-01-29 Impact factor: 3.134
Authors: David Morgonsköld; Victoria Warkander; Panayiotis Savvides; Axel Wihlborg; Mathilde Bouzereau; Hans Möller; Paul Gerdhem Journal: World J Orthop Date: 2019-01-18