Reliability and application of the new morphological classification system for chronic symptomatic osteoporotic thoracolumbar fracture

Abstract ObjectiveThis study proposed a new classification system for Chronic Symptomatic Osteoporotic Thoracolumbar Fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years. However, the lack of a standard classification system has resulted in inconveniences regarding communication, research and treatment. Previous studies of CSOTF classification exhibit different defects, and none of these studies are widely accepted.MethodsWe collected 368 cases of CSOTF in our hospital from January 2010 to June 2017 and systematically analyzed the imaging data of all patients to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans and magnetic resonance imaging. Ten investigators systematically studied and fully understood the classification system grading 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability.ResultsThe new classification system for CSOTF was divided into types I-V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively).ConclusionsThe new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The system is convenient for communication and research, but wide clinical application are needed to confirm its effectiveness and guide clinical treatment.