title: The influence of fracture mechanism and morphology on the reliability and validity of two novel thoracolumbar injury classification systems.
abstract: METHODS
  The Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) were prospectively evaluated.
  
  
  OBJECTIVE
  To compare the reliability and validity of the TLISS and TLICS schemes to determine the importance of injury mechanism and morphology to the identification and treatment of thoracolumbar fractures.
  
  
  BACKGROUND
  Two novel algorithms have been developed for the categorization and management of thoracolumbar injuries: the TLISS system emphasizing injury mechanism and the TLICS scheme involving injury morphology.
  
  
  METHODS
  The clinical and radiographic findings of 25 patients with thoracolumbar fractures were prospectively presented to 5 groups of surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored, first using the TLISS and then 3 months later with the TLICS. The recommended treatments proposed by the 2 schemes were compared with the actual management of each patient.
  
  
  RESULTS
  For both algorithms, the interrater kappa statistics of all subgroups (mechanism/morphology, status of the posterior ligaments, total score, predicted management) were within the range of moderate to substantial reproducibility (0.45-0.74), and there were no statistically significant differences noted between the respective kappa values. Interrater correlation was higher for the TLISS paradigm on mechanism/morphology, integrity of the posterior ligaments, and proposed management (P < or = 0.01). The TLISS and TLICS schemes both exhibited excellent overall validity.
  
  
  CONCLUSIONS
  Although both schemes were noted to have substantial reproducibility and validity, our results indicate the TLISS is more reliable than the TLICS, suggesting that the mechanism of trauma may be a more valuable parameter than fracture morphology for the classification and treatment thoracolumbar injuries. Since these injury characteristics are interrelated and are critical to the maintenance of spinal stability, we think that both concepts should be considered during the assessment and management of these patients.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA 19107, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Whang
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Kornelius A
authors.initials: KA
authors.lastname: Poelstra
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
authors.forename: R John
authors.initials: RJ
authors.lastname: Hurlbert
authors.forename: Paul
authors.initials: P
authors.lastname: Anderson
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.forename: Lali H S
authors.initials: LH
authors.lastname: Sekhon
authors.forename: Ralf
authors.initials: R
authors.lastname: Gahr
authors.forename: John A
authors.initials: JA
authors.lastname: Carrino
mesh_terms: D000465:Algorithms; D002490:Central Nervous System / Q000503:physiopathology; D006801:Humans; D015601:Injury Severity Score; D017846:Longitudinal Ligaments / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000473:pathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology