Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert's perspective?

STUDY DESIGN: Online questionnaire survey. OBJECTIVE: To obtain the opinion of experts on whether the currently available classification systems for thoracolumbar and subaxial cervical spine injuries meet their expectations with regard to the desired objectives of a good classification system and practical implementability. METHODS: An online survey was conducted during August-September 2013 using a specially designed questionnaire. Members of Spine Trauma Study Group of International Spinal Cord Society and other spinal injury experts were approached, and responses were analyzed. RESULTS: Forty-two spine experts responded. Majority (87.50%, n=35) were involved with education and research. For subaxial cervical spine injuries, Allen Ferguson classification was more commonly used (37.50%, n=15) and thought to be practically implementable in day-to-day practice (30.77%). For thoracolumbar injuries, while Thoracolumbar Injury Classification and Severity Score (TLICS) was more commonly used (47.50%, n=19), the response of experts for practical implementability in day-to-day practice was more evenly distributed among TLICS, AO (Association for Osteosynthesis) and Dennis classifications (30.77, 23.08 and 25.64%, respectively). Experts felt that the classification systems did not serve all the desired objectives. The reliability for residents was especially a concern. CONCLUSION: We may still be far from an ideal classification system. Many experts continue to prefer or would consider shifting back to traditional and simpler systems. There is a need for developing classification systems that would be better implementable practically in day-to-day clinical practice, better guide treatment, be more reliable, incorporate other modifiers influencing treatment and be more comprehensive in that order of priority.

Retrospective analysis of spinal trauma in patients with ankylosing spondylitis: a descriptive study in Indian population.

OBJECTIVE: This study aims to understand the demographics, mode of trauma, hospital stay, complications, neurological improvement, mortality and expenditure incurred by Indian patients with spinal trauma and ankylosing spondylitis (AS). METHODS: Retrospective analysis of the patient data admitted to a tertiary referral hospital from 2008 to 2013 with the diagnosis of AS and spinal trauma was carried out. The variables studied were demographics, mode of trauma, neurological status, neurological improvement, involved vertebral level, duration of hospital stay, comorbid factors, expenditure and complications during the stay. RESULTS: Forty-six patients with diagnosis of AS with spine trauma were admitted over the last 5 years with a total of 52 fractures. All were male patients; 58.6% had injury because of trivial trauma and 78.2% patients presented with neurological injury. C5 C6, C6 C7, C7 D1 and D12 were the most common injured level. Fractures through intervertebral disc were most common in cervical spine. Of the patients, 52.7% had shown neurological improvement of at least grade 1(AIS). Mean expenditure of patient admitted with spinal cord injury (SCI) with AS is 7957 USD (United States dollar), which is around five times the per capita income in India (as per year 2013). CONCLUSION: Males with AS are much more prone to spinal fractures than females and its incidence may be higher than previously reported. Domestic falls are the most common mechanism of spinal trauma in this population. High velocity injuries are associated with complete SCI. The study reinforces the need for development of subsidized spinal care services for SCI management.