A Novel Classification of Single-segment Thoracolumbar Tuberculosis and Its Reliability Analysis
Jiani Li, Haoxin Jiang, Yu Liu, Xuhong Xue, Zhiqiang Zhou, Fan Feng, Liuxue Du, Xu Xiong, Jiangwei Chen, Rongping Zhou, Ning Zhang, Zhili Liu, Jiaming LiuStudy Design:
A multicenter retrospective study.
Objective:
This study aims to propose a novel classification for single-segment thoracolumbar tuberculosis (TLTB) and test its reliability for clinical application.
Summary of Background Data:
The classifications of spinal tuberculosis reported by studies exhibit certain limitations with low utilization.
Methods:
The proposed classification included 3 types of single-segment TLTB based on lesion extent, vertebral and/or intervertebral disc height loss, sagittal index, spinal instability, and neurological deficit: type I, involves an intervertebral disc or a single vertebral body or an intervertebral disc along with its adjacent superior and inferior vertebrae, without spinal instability, subdivided into 3 subtypes according to lesion extent; type II involves the affected segment with concomitant spinal instability, divided into 4 subtypes according to lesion extent and bone defects; type III involves an intervertebral disc and its adjacent superior and inferior vertebrae, with spinal instability and kyphosis, divided into 3 subtypes according to bone defects. The reliability of the classification was assessed by 10 observers twice from different institutions at a 1-month interval. The Fleiss Kappa coefficient and Spearman correlation analysis were performed.
Results:
A total of 210 patients were included in study, with type Ia (16 cases, 7.6%), type Ib (19 cases, 9.0%), type Ic (24 cases, 11.4%), type IIa (20 cases, 9.5%), type IIb (23 cases, 11.0%), type IIc (19 cases, 9.0%), type IId (28 cases, 13.3%), type IIIa (19 cases, 9.0%), type IIIb (24 cases, 11.4%), and type IIIc (18 cases, 8.6%). Interobserver reliability was “nearly perfect,” with a mean Fleiss Kappa coefficient of 0.85, and all Spearman correlation coefficients exceeded 0.9. Intraobserver reliability was also “nearly perfect,” with a mean Fleiss Kappa coefficient of 0.88 and a mean Spearman correlation coefficient of 0.97.
Conclusions:
The proposed classification demonstrates excellent reliability and provides a standardized framework for single-segment TLTB.