Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study

Kaul, Rahul; Chhabra, Harvinder Singh; Vaccaro, Alexander R.; Abel, Rainer; Tuli, Sagun; Shetty, Ajoy Prasad; Das, Kali Dutta; Mohapatra, Bibhudendu; Nanda, Anil; Sangondimath, Gururaj; Bansal, Murari Lal; Patel, Nishit

doi:10.1007/s00586-016-4663-5

Cited by 47 publications

(46 citation statements)

References 34 publications

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“…Various studies have focused on the reliability and safety of TLICS and AO (7,8,15,18,19,21 (4) found that the treatment recommendations of TLICS matched surgical treatment in 47 of 49 patients (96%). However, it should be noted that almost all the papers that mention the safety and reliability of TLICS belong to the authors that have developed the system.…”

Section: █ Conclusionmentioning

confidence: 99%

“…In a recent review article, the authors emphasized the need for well-designed multicenter prospective studies to improve the evidence of the safety of TLICS (3). On the other hand, AO is more inclusive regarding the detailed assessment of the fracture morphology describing more than 50 subtypes of fractures although this complexity limits its clinical utility in daily practice (8). A correlation between TLICS and AO systems has also been reported in the literature which opposes the idea of the superiority of the systems to each other (4).…”

Section: █ Conclusionmentioning

confidence: 99%

“…AO is a more detailed system regarding the fracture morphology, describing more than 50 subtypes of fractures (8). Although widely used, the AO system is criticized for its undervaluing the severity of neurological damage and PLC injury.…”

Section: █ Introductionmentioning

confidence: 99%

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Is thoracolumbar injury classification and severity score (tlics) superior to ao thoracolumbar injury classification system for guiding the surgical management of unstable thoracolumbar burst fractures without neurologic deficit?

Yüksel¹,

Gürbüz²,

İş³

et al. 2016

Turkish Neurosurgery

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AIm: To determine whether the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine Thoracolumbar Injury Classification System have any superiority to each other regarding the reliability of their recommendations in the surgical management of unstable thoracolumbar burst fractures. mATERIAl and mEThODS: Fifty-five consecutive patients with thoracolumbar burst fractures undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. TLICS and AO systems were compared based on patients' American Spinal Injury Association (ASIA) scores and they were analyzed for their safety and reliability.RESulTS: A total of 55 patients were studied. Neurological deficits were detected in 18 patients and the remaining 37 patients had normal neurological functions. All the patients with neurological deficits received >4 points according to TLICS. There were 14 patients with incomplete spinal cord injury and all of them received >4 points according to TLICS (p<0.01). On the other hand; 8 of these 14 patients received 4 points according to the AO system. None of the 37 patients without neurological deficit received <4 points of TLICS whereas 18 of these 37 patients received 3 AO points, to whom AO recommends conservative treatment despite the fact that they had unstable burst fractures (p<0.01). CONCluSION:Recommendations of TLICS might be more reliable than those of AO particularly for guiding the surgical management of unstable thoracolumbar burst fractures without neurological deficit. However, this conclusion needs to be verified with further multicenter prospective studies.

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Section: █ Conclusionmentioning

confidence: 99%

Section: █ Conclusionmentioning

confidence: 99%

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Is thoracolumbar injury classification and severity score (tlics) superior to ao thoracolumbar injury classification system for guiding the surgical management of unstable thoracolumbar burst fractures without neurologic deficit?

Yüksel¹,

Gürbüz²,

İş³

et al. 2016

Turkish Neurosurgery

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“…Наиболее спорной составляющей классификации AOSpine явля-ется оценка морфологии повреждения. В то время как оценка неврологического статуса и применения клинических модификаторов не вызывает вопросов [12].…”

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“…Результаты ряда работ, выполненных за рубежом, не позволяют сделать окончательный вывод о надежности классификации АОSpine для систематизации повреждений позвоночника [11][12][13][14]. Кроме того, российские специалисты подобного исследования до настоящего времени не проводили.…”

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Analysis of inter-expert agreement when working with the AOSpine classification (TLCS, 2013): our experience, questions and contradictions

et al. 2019

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Objective. To assess inter-expert agreement among spine surgeons having different levels of clinical experience when working with the AOSpine classification (TLCS, 2013). Materials and Methods. The study involved nine surgeons divided into three equal groups depending on work experience. All respondents were asked to classify the MSCT data of 50 patients with acute injuries to the thoracic and lumbar spine pursuant to TLCS (2013) classification. To evaluate inter-expert agreement, a Kappa coefficient interpreted according to Landis-Koch criteria was used. Results. The overall coefficient of inter-expert agreement for all observations among all groups of respondents was 0.43, which reflects a moderate level of agreement. Moderate inter-expert agreement was revealed for injury types A (0.45) and C (0.56), and satisfactory-for type B (0.34). The highest levels of agreement were obtained for subtypes A1 (0.67) and A4 (0.80) in the group of advanced specialists and for type C (0.70) in the group of specialists with a basic level of experience. Conclusion. The study demonstrated predominantly moderate level of inter-expert agreement when working with the AOSpine classification (TLCS, 2013). The accuracy of its use increases with a gain in practical experience of a surgeon.

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Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons

Laubach

Pishnamaz

Scholz

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Atlas (C1) fractures are commonly rated according to the Gehweiler classification, but literature on its reliability is scarce. In addition, evaluation of fracture stability and choosing the most appropriate treatment regime for C1-injuries are challenging. This study aimed to investigate the interobserver reliability of the Gehweiler classification and to identify whether evaluation of fracture stability as well as the treatment of C1-fractures are consistent among spine surgeons. Methods Computed tomography images of 34 C1-fractures and case-specific information were presented to six experienced spine surgeons. C1-fractures were graded according to the Gehweiler classification, and the suggested treatment regime was recorded in a questionnaire. For data analyses, SPSS was used, and interobserver reliability was calculated using Fleiss’ kappa (κ) statistics. Results We observed a moderate reliability for the Gehweiler classification (κ = 0.50), the evaluation of fracture stability (κ = 0.50), and whether a surgical or non-surgical therapy was indicated (κ = 0.53). Type 1, 2, 3a, and 5 fractures were rated stable and treated non-surgically. Type 3b fractures were rated unstable in 86.7% of cases and treated by surgery in 90% of cases. Atlas osteosynthesis was most frequently recommended (65.4%). Overall, 25.8% of type 4 fractures were rated unstable, and surgery was favoured in 25.8%. Conclusion We found a moderate reliability for the Gehweiler classification and for the evaluation of fracture stability. In particular, diverging treatment strategies for type 3b fractures emphasise the necessity of further clinical and biomechanical investigations to determine the optimal treatment of unstable C1-fractures.

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Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study

Cited by 47 publications

References 34 publications

Is thoracolumbar injury classification and severity score (tlics) superior to ao thoracolumbar injury classification system for guiding the surgical management of unstable thoracolumbar burst fractures without neurologic deficit?

Is thoracolumbar injury classification and severity score (tlics) superior to ao thoracolumbar injury classification system for guiding the surgical management of unstable thoracolumbar burst fractures without neurologic deficit?

Analysis of inter-expert agreement when working with the AOSpine classification (TLCS, 2013): our experience, questions and contradictions

Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons

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