Reliability of a Novel Classification System for Thoracolumbar Injuries: The Thoracolumbar Injury Severity Score

Vaccaro, Alexander R.; Baron, Eli M.; Sanfilippo, James A.; Jacoby, Sidney M.; Steuve, Jacob; Grossman, Eric L; DiPaola, Matthew J.; Ranier, Paul; Austin, Luke; Ropiak, Ray; Ciminello, Michael; Okafor, Chuka; Eichenbaum, Matthew D.; Rapuri, Venkat; Smith, Eric M.; Orozco, Fabio; Ugolini, Peter; Fletcher, M.; Minnich, Jonathan; Goldberg, Gregory I.; Wilsey, Jared; Lee, Joon Y.; Lim, Moe R.; Burns, Anthony S.; Marino, Ralph J.; DiPaola, Christian P.; Zeiller, Laura; Zeiler, Steven C; Harrop, James S.; Anderson, D. Greg; Albert, Todd J.; Hilibrand, Alan S.

doi:10.1097/01.brs.0000218072.25964.a9

Cited by 119 publications

(82 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…16 Although as a whole it had an excellent construct validity, interobserver agreement for injury mechanism was only fair (kappa = 0.33). [17][18][19] This led to introduction of the Thoracolumbar Injury Classification and Severity Score (TLICS) in which fracture mechanism was replaced by description of morphological injury. 20 Others have pointed out some inherent limitations even in the recent TLICS classification system.…”

Section: Introductionmentioning

confidence: 99%

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

2014

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

2014

View full text Add to dashboard Cite

show abstract

“…Our analysis also corroborates the results for the reliability of the TLICS/TLISS classification, as excellent results were obtained in regard to agreement between the treatments indicated by the classification and the treatment indicated by the evaluating surgeons, as previously demonstrated in various publications. 10,7,8,12,14,15 We attribute the findings of our study to the fact that the new classification was well established before the case analysis. In addition to receiving the original article and a summary version in Portuguese a week earlier, on the day of the evaluation, the surgeons attended an oral presentation about the TLICS system and received an explanatory summary about it.…”

Section: Discussionmentioning

confidence: 74%

“…And a small addition was included: in compression fractures, just as a burst fracture increases the score by a point, an angulation of more than 15 degrees in the coronal plane is assigned an additional point. Vaccaro et al, 10 in a study of seventy-one cases with five evaluators using the TLISS system, reported mild interobserver agreement for this classification.…”

Section: Discussionmentioning

confidence: 99%

Interobserver evaluation of TLICS system to treat thoracolumbar fractures

et al. 2015

View full text Add to dashboard Cite

Objective: To evaluate the interobserver agreement regarding the TLICS Classification (Thoracolumbar Injury Classification and Severity Score). Furthermore, evaluate the reliability, analyzing the correlation between the treatment indicated by TLICS system (surgical or conservative) and the treatment indicated by each evaluator surgeon. Methods: Imaging tests and clinical data of 22 patients with thoracolumbar fractures were analyzed by eight spine surgeons, and two main analyzes were performed: the first compared the interobserver agreement related to TLICS and the second compared the agreement between the treatment indicated by TLICS classification (surgical or conservative) and treatment indicated by each surgeon -based on his personal experience and the preferred classification. Results: Using the parameters of Landis and Koch for interpretation of Kappa value, the interobserver agreement of TLICS classification was considered moderate in our study (K=0.6). The agreement between the indications of treatment (surgical or conservative) dictated by the classification and the indication of each surgeon was considered excellent, with kappa value of 0.89. Conclusion: We believe that the classification is a good tool for the evaluation and the treatment indication in thoracolumbar fractures.Keywords: Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Spinal cord injuries. RESUMO Objetivos: Avaliar a concordância interobservadores com relação à Classificação TLICS (Thoracolumbar Injury Classification and Severity Score). Além disso, avaliar a confiabilidade, analisando a concordância entre o tratamento indicado pelo sistema TLICS (cirúrgico ou conservador) e o tratamento que cada cirurgião avaliador indicou. Métodos: Foram avaliados retrospectivamente exames de imagem e dados clínicos de 22 pacientes com fraturas toracolombares por oito cirurgiões de coluna vertebral. Duas análises principais foram realizadas: a primeira comparando a concordância do sistema TLICS interobservadores e a segunda comparando a concordância entre o tratamento indicado por essa classificação (cirúrgico ou conservador) e o tratamento que cada cirurgião indicou -com base em sua experiência pessoal e na classificação de escolha. Resultados: Utilizando os parâmetros de Landis e Koch para interpretação do valor de Kappa, a concordância interobservadores da classificação TLICS foi considerada moderada em nosso estudo, com valor de Kappa de 0,6. A concordância entre as indicações de tratamento (cirúrgico ou conservador) ditadas pela classificação e as indicações de cada cirurgião foi considerada excelente, com valor de

show abstract

“…2,8,9 Burst-type fractures may be present in up to 60% of these patients, 8,9 with a greater incidence of fractures in the thoracolumbar segment of the spine. [10][11][12] The same correlations were observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Is there a difference between narrowing of the spinal canal and neurological deficits comparing Denis and Magerl classifications?

Caffaro

Avanzi

2010

Spinal Cord

View full text Add to dashboard Cite

Study design: Retrospective chart review. Objectives: The objective of the current study was to evaluate the correlation between neurological deficits and the severity of narrowing of the spinal canal in patients with thoracic, thoracolumbar and lumbar burst-type fractures by comparing the classifications of Denis and Magerl. From 1989 to 2005, a total of 227 patients with burst fractures following Denis' criteria were studied. Setting: Tertiary teaching institution. Methods: Computed tomographic scans of the fractured spine were analyzed to assess the narrowing of the spinal canal. Following Magerl's criteria, patients were later subdivided into two groups according to the presence of associated ligament injuries, out of which 185 patients had no such injuries and the remaining 42 patients were classified as Megerl group B. Results: Results were evaluated based on the initial neurological status of patients according to Frankel and based on the midsagittal diameter of the fractured vertebra. A significant correlation was found between the narrowing of the spinal canal and neurological deficits in both classifications, with no significant differences between either. Conclusion: The percentage of narrowing of the spinal canal proved to be a pre-disposing factor for the severity of the neurological status in thoracolumbar and lumbar burst-type fractures according to the classifications of Denis and Magerl. The greater the bone fragment in the spinal canal, the greater will be the probability of neurological deficits in both fracture classifications, equally.

show abstract

Reliability of a Novel Classification System for Thoracolumbar Injuries: The Thoracolumbar Injury Severity Score

Abstract: The TLISS has good reliability and compares favorably to other contemporary thoracolumbar fracture classification systems.

Cited by 119 publications

References 27 publications

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

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

Interobserver evaluation of TLICS system to treat thoracolumbar fractures

Is there a difference between narrowing of the spinal canal and neurological deficits comparing Denis and Magerl classifications?

Contact Info

Product

Resources

About