Comparative Reliability of 3 Thoracolumbar Fracture Classification Systems

Lenarz, Christopher J.; Place, Howard M.; Lenke, Lawrence G.; Alander, Dirk H.; Oliver, Dana

doi:10.1097/bsd.0b013e31818a38cd

Cited by 33 publications

(24 citation statements)

References 7 publications

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“…This decreased to 0.48 in the radiologists subgroup, although 1 musculoskeletal radiologist obtained the best agreement. These data coincide with those obtained by Lenarz et al, 15 who demonstrated greater interobserver reliability with CT among the spinal surgeon group (kappa50.71) compared with the nonspinal surgeon group (kappa50.52). This difference may be due to the fact that surgery offers the possibility of learning to recognize fracture patterns on imaging modalities along with the experience of direct contact with its real morphology.…”

Section: Discussionsupporting

confidence: 90%

MRI Reliability in Classifying Thoracolumbar Fractures According to AO Classification

Salgado¹,

Pizones²,

Sánchez-Mariscal³

et al. 2013

Orthopedics

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The vertebral fracture patterns of AO classification have been established historically via radiograph and computed tomography analysis, achieving modest reproducibility values. The authors hypothesize that magnetic resonance imaging may improve reliability because it better indicates posterior ligamentous complex damage. They conducted a retrospective analysis of a prospective recruited cohort of patients using radiographs and magnetic resonance images with fat saturation sequences to classify 37 traumatic vertebral fractures. Five spine surgeons, 2 orthopedic residents, 2 musculoskeletal radiologists, and 2 radiodiagnosis residents classified the morphological pattern of each fracture per AO classification in 2 separate sessions that occurred 6 weeks apart. Inter- and intraobserver reproducibility for AO classification types A, B, and C were assessed using the kappa test (pairwise method), and standard error was assessed using the jackknife method. Quantitative comparisons were performed using the Student's t test, and the kappas were performed using normal approximation. Mean interobserver agreement was kappa=0.53 and 0.47 for the first and second sessions, respectively, for all evaluators. Greater interobserver agreement was observed between the senior doctors (kappa=0.59 and 0.54 for the first and second sessions, respectively) vs residents (kappa=0.45 and 0.31 for the first and second sessions, respectively) (P=.02) and between orthopedic surgeons vs radiologists (kappa=0.71 vs 0.48, respectively) (P=.008). Mean intraobserver agreement was kappa=0.58 (range, 0.38-0.76). Evaluators more familiar with the classification obtained higher kappas. Magnetic resonance imaging offers moderate reproducibility in assessing vertebral fractures pursuant to AO classification, and results are slightly better than those reported with computed tomography. Reliability increases in the hands of experiened spine surgeons and improves with greater familiarization with the classification.

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Section: Discussionsupporting

confidence: 90%

MRI Reliability in Classifying Thoracolumbar Fractures According to AO Classification

Salgado¹,

Pizones²,

Sánchez-Mariscal³

et al. 2013

Orthopedics

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“…The study by Lenarz et al 32 was on the objective to compare and evaluate the reliability of the Denis, AO and TLISS classification systems. They concluded that the highest reliability was for the attending and senior resident group (kappa = 0.71, 0.79, 0.70) and the lowest for the junior resident and non-spine-attending surgeon group (kappa = 0.52, 0.52, 0.45).…”

Section: Discussionmentioning

confidence: 99%

Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert’s perspective?

2014

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Study design: Online questionnaire survey. Objective: To obtain the opinion of experts on whether the currently available classification systems for thoracolumbar and subaxial cervical spine injuries meet their expectations with regard to the desired objectives of a good classification system and practical implementability. Methods: An online survey was conducted during August-September 2013 using a specially designed questionnaire. Members of Spine Trauma Study Group of International Spinal Cord Society and other spinal injury experts were approached, and responses were analyzed. Results: Forty-two spine experts responded. Majority (87.50%, n = 35) were involved with education and research. For subaxial cervical spine injuries, Allen Ferguson classification was more commonly used (37.50%, n = 15) and thought to be practically implementable in day-to-day practice (30.77%). For thoracolumbar injuries, while Thoracolumbar Injury Classification and Severity Score (TLICS) was more commonly used (47.50%, n = 19), the response of experts for practical implementability in day-to-day practice was more evenly distributed among TLICS, AO (Association for Osteosynthesis) and Dennis classifications (30.77, 23.08 and 25.64%, respectively). Experts felt that the classification systems did not serve all the desired objectives. The reliability for residents was especially a concern. Conclusion: We may still be far from an ideal classification system. Many experts continue to prefer or would consider shifting back to traditional and simpler systems. There is a need for developing classification systems that would be better implementable practically in day-to-day clinical practice, better guide treatment, be more reliable, incorporate other modifiers influencing treatment and be more comprehensive in that order of priority.

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“…12 Several classifications have appeared over time regarding spinal fractures, aimed at defining their level of deformity, stability and neurological risk, 13 according to vertebral morphology, the integrity of soft tissues, especially of the posterior ligamentous complex, 14 or the neurological risk. The references contain a great many articles which assess these classifications using correlation, concordance or reproducibility 15,16,12,17 and they usually conclude that there is a need for additional studies to prove the superiority of one of these classifications over the others. 18---20 For the diagnosis of patients with spinal column trauma with suspicion of severity, CT is the method of choice to assess the degree of vertebral collapse and measure the diameter of the spinal canal.…”

Section: Discussionmentioning

confidence: 99%

Concordance in the radiological diagnosis of thoracolumbar spine fractures

Hirschfeld

Uribe

Cerván

et al. 2015

Revista Española de Cirugía Ortopédica y Traumatología (English

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Comparative Reliability of 3 Thoracolumbar Fracture Classification Systems

Abstract: As a management tool, the TLISS seems to be an acceptably reliable system when compared with the Denis and AO systems. There is a base level of knowledge and familiarity necessary for the application of the system at reliable levels.

Cited by 33 publications

References 7 publications

MRI Reliability in Classifying Thoracolumbar Fractures According to AO Classification

MRI Reliability in Classifying Thoracolumbar Fractures According to AO Classification

Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert’s perspective?

Concordance in the radiological diagnosis of thoracolumbar spine fractures

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