Citation

Lewkonia P, Paolucci EO, Thomas K. Spine 2012; 37(26): 2161-2167.

Affiliation

1Division of Orthopaedics, Department of Surgery, University of Calgary 2Department of Surgery, University of Calgary.

Copyright

(Copyright © 2012, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e3182601469

PMID

22648029

Abstract

Study Design. Experts were asked to score a series of thoracic and lumbar spine fracture cases to assess the reliability of TLICS in simulated clinical scenarios.Objective. To determine the inter and intra-observer reliability of TLICS compared to the Denis classification system, and to assess differences based on rater characteristics.Summary of Background Data. TLISS and TLICS have both been subjected to reliability testing using less robust statistical analysis. Both systems have demonstrated poor to good reliability, with particularly weak agreement on the status of the posterior ligamentous complex.Methods. Fifty-four spine fracture cases were selected from a chart review. These cases were scored on two occasions by 11 experts using both TLICS and the Denis classification systems. Reliability was assessed using a generalizability coefficient. The primary outcome was inter-observer reliability. Secondary outcomes were intra-observer reliability, difference between orthopaedic and neurosurgeons, as well as trainees and consultants, and correlation with treatment recommendations.Results. TLICS demonstrated good inter-observer agreement of 0.73 to 0.74. The PLC component was the least reliable. The Denis classification also demonstrated good reliability between observers, but was least reliable for flexion-distraction injuries. In addition, inter-observer reliability between the Denis classification and TLICS morphology subcomponent was strong. TLICS also predicted the need for operative treatment as determined by the experts scoring the injuries.Conclusion. TLICS is a reliable system for assessing fractures of the thoracic and lumbar spine when used by experts. Similar to previous studies, the PLC subcomponent score was the least reliable component. Reliability assessment using a generalizability coefficient is a robust method for validating fracture classifications.

Language: en