Reliability and Clinical Usefulness of Current Classifications in Traumatic Thoracolumbar Fractures: A Systematic Review of the Literature

I. Curfs*, M. Schotanus, W.L.W. Van Hemert, M. Heijmans, R.A. De Bie, L.W. Van Rhijn, P.C.P.H. Willems

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Web of Science)

Abstract

Background: A validated classification remains the key to an appropriate treatment algorithm of traumatic thoracolumbar fractures. Considering the development of many classifications, it is remarkable that consensus about treatment is still lacking. We conducted a systematic review to investigate which classification can be used best for treatment decision making in thoracolumbar fractures.Methods: A comprehensive search was conducted using PubMed, Embase, CINAHL, and Cochrane using the following search terms: classification (mesh), spinal fractures (mesh), and corresponding synonyms. All hits were viewed by 2 independent researchers. Papers were included if analyzing the reliability (kappa values) and clinical usefulness (specificity or sensitivity of an algorithm) of currently most used classifications (Magerl/AO, thoracolumbar injury classification and severity score [TLICS] or thoracolumbar injury severity score, and the new AO spine).Results: Twenty articles are included. The presented kappa values indicate moderate to substantial agreement for all 3 classifications. Regarding the clinical usefulness, > 90% agreement between actual treatment and classification recommendation is reported for most fractures. However, it appears that over 50% of the patients with a stable burst fracture (TLICS 2, AO-A3/A4) in daily practice are operated, so in these cases treatment decision is not primarily based on classification.Conclusion: AO, TLICS, and new AO spine classifications have acceptable accuracy (kappa > 0.4), but are limited in clinical usefulness since the treatment recommendation is not always implemented in clinical practice. Differences in treatment decision making arise from several causes, such as surgeon and patient preferences and prognostic factors that are not included in classifications yet. The recently validated thoracolumbar AO spine injury score seems promising for use in clinical practice, because of inclusion of patient-specific modifiers. Future research should prove its definite value in treatment decision making.
Original languageEnglish
Pages (from-to)956-969
Number of pages14
JournalInternational Journal of Spine Surgery
Volume14
Issue number6
DOIs
Publication statusPublished - 1 Dec 2020

Keywords

  • ao spine
  • burst fractures
  • classification
  • clinical usefulness
  • fractures
  • injury classification
  • integrity
  • interrater reliability
  • lumbar spine
  • posterior ligamentous complex
  • reliability
  • reproducibility
  • severity score
  • thoracolumbar spine
  • tlics
  • validity
  • SEVERITY SCORE
  • TLICS
  • INTERRATER RELIABILITY
  • INTEGRITY
  • INJURY CLASSIFICATION
  • LUMBAR SPINE
  • AO SPINE
  • VALIDITY
  • POSTERIOR LIGAMENTOUS COMPLEX
  • AO spine
  • REPRODUCIBILITY
  • BURST FRACTURES

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