A Novel Classification of Single-segment Thoracolumbar Tuberculosis and Its Reliability Analysis: A Multicenter Study.

STUDY

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.