• Alexander R Vaccaro, Eli M Baron, James Sanfilippo, Sidney Jacoby, Jacob Steuve, Eric Grossman, Matthew DiPaola, Paul Ranier, Luke Austin, Ray Ropiak, Michael Ciminello, Chuka Okafor, Matthew Eichenbaum, Venkat Rapuri, Eric Smith, Fabio Orozco, Peter Ugolini, Mark Fletcher, Jonathan Minnich, Gregory Goldberg, Jared Wilsey, Joon Y Lee, Moe R Lim, Anthony Burns, Ralph Marino, Christian DiPaola, Laura Zeiller, Steven C Zeiler, James Harrop, D Greg Anderson, Todd J Albert, and Alan S Hilibrand.
• Thomas Jefferson University Hospital, Philadelphia, PA, USA. alexvaccaro3@aol.com
• Spine. 2006 May 15;31(11 Suppl):S62-9; discussion S104.

Study DesignProspective 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.ObjectiveTo determine the reliability of the TLISS system.Summary Of Background DataThe 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.MethodsA 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.ResultsInterrater 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.ConclusionsThe TLISS has good reliability and compares favorably to other contemporary thoracolumbar fracture classification systems.

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