P K Karthik Yelamarthy1, Srinivasan Narayan Moolya2, Harvinder Singh Chhabra3, Hans Josef Erli4, Francois Theron5, Rainer Abel6, Michael Haak7, Sagun Tuli8, S L Yadav9, Md Fazlul Hoque10. 1. Consultant Spine and Orthopedic Surgeon, Udai Omni Hospital, Hyderabad, India. 2. Tejasvini Hospital, SSIOT Manglore, Manglore, India. 3. Chief of Spine Services & Medical Director, Indian Spinal Injuries Center Sector - C, Vasant Kunj, New Delhi, India. issicon@isiconline.org. 4. Ret. Director of the Department of Spine Surgery, Vivantes Humboldt Hospital, Berlin, Germany. 5. Lecturer in Orthopedics, University of Pretoria, Pretoria, South Africa. 6. Doctor of Medicine, Klinikum Bayreuth GmbH, Orthopedic Surgery, Bayreuth, Germany. 7. Chief, Orthopaedic Spine Surgery, Director, Orthopaedic Spine Fellowship, Geisinger Health System, Danville, PA, USA. 8. Spine Neurosurgeon, Head Florida Spinal Surgery Center, Miami, FL, USA. 9. Department of Physical Medicine & Rehabilitation, All India Institute of Medical Sciences, New Delhi, India. 10. Senior Consultant Orthopaedic and Spinal Surgery Square Hospitals Ltd, Dhaka, Bangladesh.
Abstract
STUDY DESIGN: Development and validation of fracture classification system. OBJECTIVE: To develop and validate a Simplified Classification System (SCS) for Thoraco-Lumbar (TL) fractures (SCS - TL fractures). SETTING: Tertiary Spinal Injuries Centre, New Delhi, India METHODS: Based on the International Spinal Cord Society Spine Trauma Study Group (ISCoS STSG, n = 23) experts' clinical consensus conducted by the senior author and on his own experience, the Denis classification for TL fractures was modified to develop a SCS-TL fractures that could guide the management. After Face and Content validation, Construct validation was done in two stages. First stage analyzed if management of 30 cases of TL fractures, as suggested by the SCS - TL fractures and ISCoS STSG (n = 9) as well as other (n = 5) experts, matched. Second stage was a one year prospective study analyzing if the management suggested matched the management actually carried out by different spine surgeons (n = 10) working at a single institution. RESULTS: In the first stage there was 100% agreement for management (conservative or surgical) as proposed by experts and that suggested by the proposed classification for TL fractures whereas for surgical approach there was 88% agreement. In the second stage, there was 100% agreement for the management as well as surgical approach as carried out at our centre and that proposed by the SCS for TL fractures. CONCLUSIONS: The proposed SCS-TL fractures helps in classifying and in decision making for management of TL fractures. The next phase of validation would involve multicentric reliability studies and prospective application of the SCS- TL fractures.
STUDY DESIGN: Development and validation of fracture classification system. OBJECTIVE: To develop and validate a Simplified Classification System (SCS) for Thoraco-Lumbar (TL) fractures (SCS - TL fractures). SETTING: Tertiary Spinal Injuries Centre, New Delhi, India METHODS: Based on the International Spinal Cord Society Spine Trauma Study Group (ISCoS STSG, n = 23) experts' clinical consensus conducted by the senior author and on his own experience, the Denis classification for TL fractures was modified to develop a SCS-TL fractures that could guide the management. After Face and Content validation, Construct validation was done in two stages. First stage analyzed if management of 30 cases of TL fractures, as suggested by the SCS - TL fractures and ISCoS STSG (n = 9) as well as other (n = 5) experts, matched. Second stage was a one year prospective study analyzing if the management suggested matched the management actually carried out by different spine surgeons (n = 10) working at a single institution. RESULTS: In the first stage there was 100% agreement for management (conservative or surgical) as proposed by experts and that suggested by the proposed classification for TL fractures whereas for surgical approach there was 88% agreement. In the second stage, there was 100% agreement for the management as well as surgical approach as carried out at our centre and that proposed by the SCS for TL fractures. CONCLUSIONS: The proposed SCS-TL fractures helps in classifying and in decision making for management of TL fractures. The next phase of validation would involve multicentric reliability studies and prospective application of the SCS- TL fractures.
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