RESUMEN
STUDY DESIGN: Prospective study of 5 spine surgeons rating 71 clinical cases of thoracolumbar spinal injuries using the Thoracolumbar Injury Severity Score (TLISS) and then re-rating the cases in a different order 1 month later. OBJECTIVE: To determine the reliability of the TLISS system. SUMMARY OF BACKGROUND DATA: The TLISS is a recently introduced classification system for thoracolumbar spinal column injures designed to simplify injury classification and facilitate treatment decision making. Before being widely adopted, the reliability of the TLISS must be studied. METHODS: A total of 71 cases of thoracolumbar spinal trauma were distributed on CD-ROM to 5 attending spine surgeons, including clinical/radiographic data, details of the TLISS, and a scoring sheet in which cases would be scored using the system. The surgeons were later assigned the task with the cases reordered. Intraobserver and interobserver reliability was calculated for TLISS components, total score, and surgeon's treatment decision using the Cohen unweighted kappa coefficients and Spearman rank-order correlation. RESULTS: Interrater reliability assessed by generalized kappa coefficients was 0.33 +/- 0.03 for injury mechanism, 0.91 +/- 0.02 for neurologic status, 0.35 +/- 0.03 for posterior ligamentous complex status, 0.29 +/- 0.02 for TLISS total, and 0.52 +/- 0.03 for treatment recommendation. Respective results using the Spearman correlation were 0.35 +/- 0.04, 0.94 +/- 0.01, 0.48 +/- 0.04, 0.65 +/- 0.03, and 0.51 +/- 0.04. Surgeons agreed with the TLISS recommendation 96.4% of the time. Intrarater kappa coefficients were 0.57 +/- 0.04 for injury mechanism, 0.93 +/- 0.02 for neurologic status, 0.48 +/- 0.04 for posterior ligamentous complex status, 0.46 +/- 0.03 for TLISS total, and 0.62 +/- 0.04 for treatment recommendation. Respective results using the Spearman correlation were 0.70 +/- 0.04, 0.95 +/- 0.02, 0.59 +/- 0.05, 0.77 +/- 0.04, and 0.59 +/- 0.05. CONCLUSIONS: The TLISS has good reliability and compares favorably to other contemporary thoracolumbar fracture classification systems.
Asunto(s)
Vértebras Lumbares/lesiones , Índice de Severidad de la Enfermedad , Traumatismos Vertebrales/clasificación , Vértebras Torácicas/lesiones , Vértebras Lumbares/patología , Estudios Prospectivos , Reproducibilidad de los Resultados , Traumatismos Vertebrales/diagnóstico , Traumatismos Vertebrales/fisiopatología , Vértebras Torácicas/patologíaRESUMEN
BACKGROUND CONTEXT: Traumatic cervical facet dislocation accounts for a disproportionate rate of neurologic disability. The relative importance of patient and management variables, including the timing of spinal reduction, in ultimate neurologic outcome has not been well defined. PURPOSE: To analyze data from a cohort of patients sustaining traumatic cervical facet dislocation to determine the relative importance of several patient and management variables in neurologic recovery after injury. STUDY DESIGN/SETTING: A retrospective study was conducted at a major referral center for spinal-cord-injured patients. PATIENT SAMPLE: Forty-five patients sustaining traumatic cervical facet dislocation. OUTCOME MEASURES: Using improvement in American Spinal Injury Association (ASIA) motor score as the primary outcome measure, patient data were used to construct a statistical model allowing the analysis of several clinically relevant variables. METHODS: The records of patients sustaining a traumatic cervical facet dislocation over a 5-year period were reviewed. Clinical data were collected for all patients with adequate follow-up. The data were used to construct a statistical model designed to analyze the contribution of the variables age, gender, time to reduction of the spine and initial motor score to neurologic improvement (the outcome measure). In addition, the effect of variable interaction was studied. RESULTS: Most patients demonstrated neurologic improvement over the course of follow-up after cervical facet dislocation. For this data set, the variables age and initial motor score were significantly associated with neurologic improvement. However, time to reduction of the spine did not demonstrate a significant independent relationship to neurologic outcome. No significant interaction was found between patient age or gender and the time to reduction with regard to predicting neurologic recovery. CONCLUSION: The present study uses a statistical model to determine the relative importance of clinically relevant variables for a population of patients after traumatic cervical facet dislocation. This model confirms the clinical impression that younger patients with lesser degrees of neurologic injury tend to achieve the best neurologic recovery after a traumatic facet dislocation. Although a strong benefit from earlier spinal column reduction did not emerge from the present data set, additional study is needed to define those patients who would benefit from immediate reduction of the spinal column.