Introduction
Methods
Overview
Review of spine classification systems
Existing classification | Basis for classification | Classification levels | ||||
---|---|---|---|---|---|---|
WHO International Classification of Disease (ICD-10) [7] | Diagnostic codes based on pathology or location of symptoms | n/a | Acute low back (neck, thoracic) pain < 3 months | Chronic low back (neck, thoracic) pain > 3 months (same code as acute) | Over 300 specific pathological diagnoses | n/a |
WHO International Classification of Functioning, Disability and Health (ICF) [8] | Coding based on degree of impairment, limitation or activity restriction. Linked with ICD-10 codes (represented by xxx) | xxx.0 NO problem (none, absent, negligible) 0–4% | xxx.1 MILD problem (slight, low) 5–24% | xxx.2 MODERATE problem (medium, fair) 25–49% | xxx.3 SEVERE problem (high, extreme) 50–95% | xxx.4 COMPLETE problem (total) 96–100% |
Quebec Task Force on Whiplash- Associated Disorders [9] | Grading based on the presence of neck pain with or without clinical findings | Grade 0 No pain and no physical findings | Grade 1 Pain, no physical findings | Grade 2 Pain plus physical findings | Grade 3 Pain and neurological signs | Grade 4 Pain, evidence of fracture or dislocation |
Quebec Task Force on Spinal Disorders [10] | Classification based on symptoms and pathological finding a (< 7 days) b (> 7 days to 7 weeks) c (> 7 weeks) | n/a | Class 1: Pain without radiation | Class 2, 3: Pain + radiation to extremity distally | Class 4, 5, 6: Pain + radiation + neurological signs (6 with confirmed imaging) | Class 7, 8, 9, 11: Specific diagnoses. Stenosis, postsurgical, other diagnoses |
Clinical practice implications of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders [17] | Grading based on the presence of neck pain, levels of activity interference, ± radiculopathy, ± major structural pathology | No neck pain No grade | Grade I Neck pain. No major structural pathology. No or minor interference with ADL | Grade II Neck pain. No major structural pathology. Major interference with ADL | Grade III Nek pain. Neck pain, neurological signs. No major structural pathology | Grade IV Neck pain. Signs or symptoms of major structural pathology |
National Institute of Health | Differentiation of low back pain based on chronicity and impact defined by PROMIS (intensity, activity interference | n/a | Low impact: (chronic, non-chronic) Pain intensity and interference < 8 | Moderate impact: (chronic or not chronic) Pain intensity and interference > 8 – < 12 | Severe impact, not disabled: (chronic or non-chronic) Pain intensity and interference > 13 | Disabled Off work > one month: Work disability benefits, inactive |
South Australia Workcover Corporation Guidelines For The Management Of Back-Injured Employees [14] | Grouping according to symptom diagnoses and anatomic location | n/a | Group one: back symptoms (non-specific) | Group two: back strain less than 8-week duration | n/a | Group three: back pain with specific diagnoses: disk prolapse Stenosis Spondylolisthesis Facture and/or dislocation |
American Medical Association. Guides To The Evaluation Of Permanent Impairment. Fifth Edition [15] | Categories based on clinical findings = ± − Radiculopathy, ± Loss of structural integrity | Category 1: no clinical findings | Category 2: clinical findings, no persistent radiculopathy | Category 3: signs of radiculopathy | Category 4: loss of motion integrity >50% compression fracture | Category 5: both radiculopathy and loss of segmental integrity |
American Medical Association. Guides To The Evaluation of Permanent Impairment. Sixth Edition AMA [16] | Impairment classes and functional history and impairment modifiers | Class 0 or modifier 0: asymptomatic, no objective findings | Class 1 or modifier 1: pain: mild. symptoms with strenuous activity | Class 2 or modifier 2: pain: moderate. Symptoms with normal activity | Class 3 or modifier 3: pain: severe. Symptoms on minimal activity | The presence of back or neck pain with extremity pain Could be extremity joint pain |
The Global Alliance for MSK Health Global Survey Module | Absence or presence of pain, < 4 weeks, > 3 months, limitation of activities | No pain to all survey questions | Pain present, no limitation of activities < 4 weeks, > 3 months | Pain present Limitation of activities < 4 weeks, > 3 months | Pain: very severe. Symptoms at rest, limited to sedentary activity | Diagnosis by medical doctor |
Seed document
Modified Delphi process
Results
Summary of comments, responses, and modifications for each class
Class 0 = no or minimal spine symptoms, may have risk factors
Class I = mild symptoms, no interference with function or activities of daily living, no neurologic deficits and Class II = moderate or severe symptoms, interference with function or activities of daily living, no neurologic deficits
Class III = neurological signs/symptoms originating from spinal pathology
Class IV = severe spinal bone deformity, trauma, or pathology
Class V = spine-related symptoms associated with systemic or destructive pathology
GSCI spinal disorders classification
Class | Subclass |
---|---|
Class 0: No or minimal spine-related symptoms, potential for prevention, no interference with function or activities of daily living, no neurological deficits, no severe pathology | Class 0a: No evident risk factors for a spine-related disorder or pain Class 0b: One or more risk factors for a spine-related disorder or pain |
Class I: Spine-related symptoms, no or minimal interference with function or activities of daily living, no neurological deficits, no severe pathology | Class Ia: Acute or subacute, mild pain Class Ib: Chronic or recurrent, mild pain |
Class II: Spine-related symptoms, interference with function or activities of daily living, no neurological deficits, no severe pathology | Class IIa: Acute or subacute, moderate pain Class IIb: Chronic or recurrent, moderate pain Class IIc: Acute or subacute, severe pain Class IId: Chronic or recurrent, severe pain |
Class III: Spine-related symptoms with neurological symptoms or deficits, interference with function or activities of daily living, focal pathology compromising neural structures | Class IIIa: Minor and non-progressive Class IIIb: Acute, major, and progressive Class IIIc: Chronic and stable |
Class IV: Spine-related symptoms with stable, severe deformity, with or without interference with function or activities of daily living, with or without neurological deficits | Class IVa: Stable spine pathology, no correlation with symptoms Class IVb: Acute or chronic spine pathology with correlation to symptoms |
Class V: Serious spine-related symptoms with severe or systemic pathology, interference with function or activities of daily living, with or without neurological deficits | Class Va: Severe, acute spinal pathology, requires immediate intervention (emergency) Class Vb: Severe, slowly progressive spinal pathology, requires intervention (non-emergency) Class Vc: Spine symptoms originating from non-spine pathology, requires immediate intervention (emergency) |