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

James S. Harrop, Alexander R. Vaccaro, John Hurlbert, Jared T. Wilsey, Eli M. Baron, Christopher I. Shaffrey, Charles G. Fisher, Marcel F. Dvorak, F. C. Öner, Kirkham B. Wood, Neel Anand, D. Greg Anderson, Moe R. Lim, Joon Y. Lee, Christopher M. Bono, Paul M. Arnold, Y. Raja Rampersaud, Michael G. Fehlings

Research output: Contribution to journalArticle

49 Scopus citations


Object. 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.

Original languageEnglish (US)
Pages (from-to)118-122
Number of pages5
JournalJournal of Neurosurgery: Spine
Issue number2
Publication statusPublished - Feb 1 2006
Externally publishedYes



  • Classification
  • Fracture
  • Thoracolumbar spine
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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