Scott Haldeman1,2,3, Claire D Johnson4,5, Roger Chou6,7, Margareta Nordin8,9, Pierre Côté10,11, Eric L Hurwitz12, Bart N Green13,14, Deborah Kopansky-Giles15,16, Christine Cedraschi17,18, Ellen Aartun11, Emre Acaroğlu19, Arthur Ameis20, Selim Ayhan21, Fiona Blyth22, David Borenstein23, O'Dane Brady24, Fereydoun Davatchi25, Christine Goertz26,27, Najia Hajjaj-Hassouni28, Jan Hartvigsen29,30, Maria Hondras31, Nadège Lemeunier32, John Mayer33, Silvano Mior34, Tiro Mmopelwa35, Michael Modic36, Rajani Mullerpatan37, Lillian Mwaniki38, Madeleine Ngandeu-Singwe39, Geoff Outerbridge40, Kristi Randhawa10,11, Erkin Sönmez41, Carlos Torres42, Paola Torres43, William Watters44,45, Hainan Yu10,11. 1. Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. 2. Department of Neurology, University of California, Irvine, Irvine, CA, USA. 3. World Spine Care, Santa Ana, CA, USA. 4. National University of Health Sciences, Lombard, IL, USA. globalspinecareinitiative@gmail.com. 5. Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA. globalspinecareinitiative@gmail.com. 6. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA. 7. Department of Medicine, Oregon Health and Science University, Portland, OR, USA. 8. Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA. 9. World Spine Care Europe, Holmfirth, UK. 10. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada. 11. UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada. 12. Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA. 13. National University of Health Sciences, Lombard, IL, USA. 14. Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA. 15. Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada. 16. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. 17. Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland. 18. Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland. 19. ARTES Spine Center, Ankara, Turkey. 20. Faculty of Medicine, Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal, Toronto, ON, Canada. 21. ARTES Spine Center, Acibadem University, Ankara, Turkey. 22. Concord Clinical School, University of Sydney, Concord, NSW, Australia. 23. Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA. 24. World Spine Care, Tampa, FL, USA. 25. Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran. 26. Palmer College of Chiropractic, Davenport, IA, USA. 27. The Spine Institute for Quality, Davenport, IA, USA. 28. Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco. 29. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 30. Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. 31. Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA. 32. Institut Franco-Européen de Chiropraxie, Toulouse, France. 33. U.S. Spine and Sport Foundation, San Diego, CA, USA. 34. Canadian Memorial Chiropractic College, Toronto, ON, Canada. 35. ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana. 36. Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA. 37. Mahatma Gandhi Mission Institute of Health Sciences, MGM School of Physiotherapy, Navi Mumbai, Maharashtra, India. 38. Law Society of Kenya, Nairobi, Kenya. 39. Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon. 40. World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada. 41. Department of Neurological Surgery, School of Medicine, Başkent University, Ankara, Turkey. 42. Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. 43. Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile. 44. Department of Orthopedic, Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA. 45. Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA.
Abstract
PURPOSE: The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. METHODS: Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. RESULTS: Thirty-six experts from 15 countries participated. After the second round, there was 95% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0); mild symptoms (i.e., neck or back pain) but no interference with activities (class I); moderate or severe symptoms with interference of activities (class II); spine-related neurological signs or symptoms (class III); severe bony spine deformity, trauma or pathology (class IV); and spine-related symptoms or destructive lesions associated with systemic pathology (class V). Subclasses for each major class included chronicity and severity when different interventions were anticipated or recommended. CONCLUSIONS: An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. METHODS: Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. RESULTS: Thirty-six experts from 15 countries participated. After the second round, there was 95% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0); mild symptoms (i.e., neck or back pain) but no interference with activities (class I); moderate or severe symptoms with interference of activities (class II); spine-related neurological signs or symptoms (class III); severe bony spine deformity, trauma or pathology (class IV); and spine-related symptoms or destructive lesions associated with systemic pathology (class V). Subclasses for each major class included chronicity and severity when different interventions were anticipated or recommended. CONCLUSIONS: An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. These slides can be retrieved under Electronic Supplementary Material.
Authors: Richard A Deyo; Samuel F Dworkin; Dagmar Amtmann; Gunnar Andersson; David Borenstein; Eugene Carragee; John Carrino; Roger Chou; Karon Cook; Anthony DeLitto; Christine Goertz; Partap Khalsa; John Loeser; Sean Mackey; James Panagis; James Rainville; Tor Tosteson; Dennis Turk; Michael Von Korff; Debra K Weiner Journal: J Manipulative Physiol Ther Date: 2014-08-12 Impact factor: 1.437
Authors: Margareta Nordin; Kristi Randhawa; Paola Torres; Hainan Yu; Scott Haldeman; O'Dane Brady; Pierre Côté; Carlos Torres; Michael Modic; Rajani Mullerpatan; Christine Cedraschi; Roger Chou; Emre Acaroğlu; Eric L Hurwitz; Nadège Lemeunier; Jean Dudler; Anne Taylor-Vaisey; Erkin Sönmez Journal: Eur Spine J Date: 2018-02-28 Impact factor: 3.134
Authors: Claire D Johnson; Scott Haldeman; Roger Chou; Margareta Nordin; Bart N Green; Pierre Côté; Eric L Hurwitz; Deborah Kopansky-Giles; Emre Acaroğlu; Christine Cedraschi; Arthur Ameis; Kristi Randhawa; Ellen Aartun; Afua Adjei-Kwayisi; Selim Ayhan; Amer Aziz; Teresa Bas; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Jean Dudler; Robert Dunn; Stefan Eberspaecher; Juan Emmerich; Jean Pierre Farcy; Norman Fisher-Jeffes; Christine Goertz; Michael Grevitt; Erin A Griffith; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Edward J Kane; Julie Laplante; Nadège Lemeunier; John Mayer; Silvano Mior; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Shanmuganathan Rajasekaran; Heather Shearer; Matthew Smuck; Erkin Sönmez; Patricia Tavares; Anne Taylor-Vaisey; Carlos Torres; Paola Torres; Alexander van der Horst; Leslie Verville; Emiliano Vialle; Gomatam Vijay Kumar; Adriaan Vlok; William Watters; Chung Chek Wong; Jessica J Wong; Hainan Yu; Selcen Yüksel Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Deborah Kopansky-Giles; Claire D Johnson; Scott Haldeman; Roger Chou; Pierre Côté; Bart N Green; Margareta Nordin; Emre Acaroğlu; Arthur Ameis; Christine Cedraschi; Eric L Hurwitz; Selim Ayhan; David Borenstein; O'Dane Brady; Peter Brooks; Fereydoun Davatchi; Robert Dunn; Christine Goertz; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Nadège Lemeunier; John Mayer; Silvano Mior; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Kristi Randhawa; Carlos Torres; Paola Torres; Adriaan Vlok; Chung Chek Wong Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Richard A Deyo; Samuel F Dworkin; Dagmar Amtmann; Gunnar Andersson; David Borenstein; Eugene Carragee; John Carrino; Roger Chou; Karon Cook; Anthony DeLitto; Christine Goertz; Partap Khalsa; John Loeser; Sean Mackey; James Panagis; James Rainville; Tor Tosteson; Dennis Turk; Michael Von Korff; Debra K Weiner Journal: Pain Med Date: 2014-08 Impact factor: 3.750
Authors: Christine Cedraschi; Margareta Nordin; Scott Haldeman; Kristi Randhawa; Deborah Kopansky-Giles; Claire D Johnson; Roger Chou; Eric L Hurwitz; Pierre Côté Journal: Eur Spine J Date: 2018-01-27 Impact factor: 3.134
Authors: Jaime Guzman; Scott Haldeman; Linda J Carroll; Eugene J Carragee; Eric L Hurwitz; Paul Peloso; Margareta Nordin; J David Cassidy; Lena W Holm; Pierre Côté; Gabrielle van der Velde; Sheilah Hogg-Johnson Journal: J Manipulative Physiol Ther Date: 2009-02 Impact factor: 1.437
Authors: Bart N Green; Claire D Johnson; Scott Haldeman; Erin Griffith; Michael B Clay; Edward J Kane; Juan M Castellote; Shanmuganathan Rajasekaran; Matthew Smuck; Eric L Hurwitz; Kristi Randhawa; Hainan Yu; Margareta Nordin Journal: PLoS One Date: 2018-06-01 Impact factor: 3.240
Authors: Bart N Green; Claire D Johnson; Scott Haldeman; Edward J Kane; Michael B Clay; Erin A Griffith; Juan M Castellote; Matthew Smuck; Shanmuganathan Rajasekaran; Eric L Hurwitz; Margareta Nordin; Kristi Randhawa; Hainan Yu Journal: Eur Spine J Date: 2018-08-11 Impact factor: 3.134
Authors: Claire D Johnson; Scott Haldeman; Margareta Nordin; Roger Chou; Pierre Côté; Eric L Hurwitz; Bart N Green; Deborah Kopansky-Giles; Kristi Randhawa; Christine Cedraschi; Arthur Ameis; Emre Acaroğlu; Ellen Aartun; Afua Adjei-Kwayisi; Selim Ayhan; Amer Aziz; Teresa Bas; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Jean Dudler; Robert Dunn; Stefan Eberspaecher; Juan Emmerich; Jean Pierre Farcy; Norman Fisher-Jeffes; Christine Goertz; Michael Grevitt; Erin A Griffith; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Edward J Kane; Julie Laplante; Nadège Lemeunier; John Mayer; Silvano Mior; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Shanmuganathan Rajasekaran; Heather Shearer; Matthew Smuck; Erkin Sönmez; Patricia Tavares; Anne Taylor-Vaisey; Carlos Torres; Paola Torres; Alexander van der Horst; Leslie Verville; Emiliano Vialle; Gomatam Vijay Kumar; Adriaan Vlok; William Watters; Chung Chek Wong; Jessica J Wong; Hainan Yu; Selcen Yüksel Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Scott Haldeman; Claire D Johnson; Roger Chou; Margareta Nordin; Pierre Côté; Eric L Hurwitz; Bart N Green; Christine Cedraschi; Emre Acaroğlu; Deborah Kopansky-Giles; Arthur Ameis; Afua Adjei-Kwayisi; Selim Ayhan; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Robert Dunn; Christine Goertz; Erin A Griffith; Maria Hondras; Edward J Kane; Nadège Lemeunier; John Mayer; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Kristi Randhawa; Heather Shearer; Erkin Sönmez; Carlos Torres; Paola Torres; Leslie Verville; Adriaan Vlok; William Watters; Chung Chek Wong; Hainan Yu Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Claire D Johnson; Scott Haldeman; Roger Chou; Margareta Nordin; Bart N Green; Pierre Côté; Eric L Hurwitz; Deborah Kopansky-Giles; Emre Acaroğlu; Christine Cedraschi; Arthur Ameis; Kristi Randhawa; Ellen Aartun; Afua Adjei-Kwayisi; Selim Ayhan; Amer Aziz; Teresa Bas; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Jean Dudler; Robert Dunn; Stefan Eberspaecher; Juan Emmerich; Jean Pierre Farcy; Norman Fisher-Jeffes; Christine Goertz; Michael Grevitt; Erin A Griffith; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Edward J Kane; Julie Laplante; Nadège Lemeunier; John Mayer; Silvano Mior; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Shanmuganathan Rajasekaran; Heather Shearer; Matthew Smuck; Erkin Sönmez; Patricia Tavares; Anne Taylor-Vaisey; Carlos Torres; Paola Torres; Alexander van der Horst; Leslie Verville; Emiliano Vialle; Gomatam Vijay Kumar; Adriaan Vlok; William Watters; Chung Chek Wong; Jessica J Wong; Hainan Yu; Selcen Yüksel Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Deborah Kopansky-Giles; Claire D Johnson; Scott Haldeman; Roger Chou; Pierre Côté; Bart N Green; Margareta Nordin; Emre Acaroğlu; Arthur Ameis; Christine Cedraschi; Eric L Hurwitz; Selim Ayhan; David Borenstein; O'Dane Brady; Peter Brooks; Fereydoun Davatchi; Robert Dunn; Christine Goertz; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Nadège Lemeunier; John Mayer; Silvano Mior; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Kristi Randhawa; Carlos Torres; Paola Torres; Adriaan Vlok; Chung Chek Wong Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Scott Haldeman; Margareta Nordin; Roger Chou; Pierre Côté; Eric L Hurwitz; Claire D Johnson; Kristi Randhawa; Bart N Green; Deborah Kopansky-Giles; Emre Acaroğlu; Arthur Ameis; Christine Cedraschi; Ellen Aartun; Afua Adjei-Kwayisi; Selim Ayhan; Amer Aziz; Teresa Bas; Fiona Blyth; David Borenstein; O'Dane Brady; Peter Brooks; Connie Camilleri; Juan M Castellote; Michael B Clay; Fereydoun Davatchi; Jean Dudler; Robert Dunn; Stefan Eberspaecher; Juan Emmerich; Jean Pierre Farcy; Norman Fisher-Jeffes; Christine Goertz; Michael Grevitt; Erin A Griffith; Najia Hajjaj-Hassouni; Jan Hartvigsen; Maria Hondras; Edward J Kane; Julie Laplante; Nadège Lemeunier; John Mayer; Silvano Mior; Tiro Mmopelwa; Michael Modic; Jean Moss; Rajani Mullerpatan; Elijah Muteti; Lillian Mwaniki; Madeleine Ngandeu-Singwe; Geoff Outerbridge; Shanmuganathan Rajasekaran; Heather Shearer; Matthew Smuck; Erkin Sönmez; Patricia Tavares; Anne Taylor-Vaisey; Carlos Torres; Paola Torres; Alexander van der Horst; Leslie Verville; Emiliano Vialle; Gomatam Vijay Kumar; Adriaan Vlok; William Watters; Chung Chek Wong; Jessica J Wong; Hainan Yu; Selcen Yüksel Journal: Eur Spine J Date: 2018-08-27 Impact factor: 3.134
Authors: Robert D Vining; Zacariah K Shannon; Stacie A Salsbury; Lance Corber; Amy L Minkalis; Christine M Goertz Journal: J Manipulative Physiol Ther Date: 2019-12-19 Impact factor: 1.437