Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005.
OBJECTIVE
A new classification and treatment algorithm for thoracolumbar injuries was recently introduced by Vaccaro and colleagues in 2005. A thoracolumbar injury severity scale (TLISS) was proposed for grading and guiding treatment for these injuries. The scale is based on the following: 1) the mechanism of injury; 2) the integrity of the posterior ligamentous complex (PLC); and 3) the patient's neurological status. The reliability and validity of assessing injury mechanism and the integrity of the PLC was assessed.


METHODS
Forty-eight spine surgeons, consisting of neurosurgeons and orthopedic surgeons, reviewed 56 clinical thoracolumbar injury case histories. Each was classified and scored to determine treatment recommendations according to a novel classification system. After 3 months the case histories were reordered and the physicians repeated the exercise. Validity of this classification was good among reviewers; the vast majority (> 90%) agreed with the system's treatment recommendations. Surgeons were unclear as to a cogent description of PLC disruption and fracture mechanism.


CONCLUSIONS
The TLISS demonstrated acceptable reliability in terms of intra- and interobserver agreement on the algorithm's treatment recommendations. Replacing injury mechanism with a description of injury morphology and better definition of PLC injury will improve inter- and intraobserver reliability of this injury classification system.
Harrop
James S
JS
Department of Neurosurgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania, USA. james.harrop@jefferson.edu
Vaccaro
Alexander R
AR
Hurlbert
R John
RJ
Wilsey
Jared T
JT
Baron
Eli M
EM
Shaffrey
Christopher I
CI
Fisher
Charles G
CG
Dvorak
Marcel F
MF
Oner
F C
FC
Wood
Kirkham B
KB
Anand
Neel
N
Anderson
D Greg
DG
Lim
Moe R
MR
Lee
Joon Y
JY
Bono
Christopher M
CM
Arnold
Paul M
PM
Rampersaud
Y Raja
YR
Fehlings
Michael G
MG
D000465:Algorithms; D006801:Humans; D008022:Ligaments; D009460:Neurologic Examination; D015588:Observer Variation; D010347:Patient Care Planning; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013124:Spinal Injuries / Q000145:classification* / Q000209:etiology / Q000473:pathology / Q000628:therapy*