Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert's perspective?

Study design: Online questionnaire survey. Objective: To obtain the opinion of experts on whether the currently available classification systems for thoracolumbar and subaxial cervical spine injuries meet their expectations with regard to the desired objectives of a good classification system and practical implementability. Methods: An online survey was conducted during August-September 2013 using a specially designed questionnaire. Members of Spine Trauma Study Group of International Spinal Cord Society and other spinal injury experts were approached, and responses were analyzed. Results: Forty-two spine experts responded. Majority (87.50%, n = 35) were involved with education and research. For subaxial cervical spine injuries, Allen Ferguson classification was more commonly used (37.50%, n = 15) and thought to be practically implementable in day-to-day practice (30.77%). For thoracolumbar injuries, while Thoracolumbar Injury Classification and Severity Score (TLICS) was more commonly used (47.50%, n = 19), the response of experts for practical implementability in day-to-day practice was more evenly distributed among TLICS, AO (Association for Osteosynthesis) and Dennis classifications (30.77, 23.08 and 25.64%, respectively). Experts felt that the classification systems did not serve all the desired objectives. The reliability for residents was especially a concern. Conclusion: We may still be far from an ideal classification system. Many experts continue to prefer or would consider shifting back to traditional and simpler systems. There is a need for developing classification systems that would be better implementable practically in day-to-day clinical practice, better guide treatment, be more reliable, incorporate other modifiers influencing treatment and be more comprehensive in that order of priority.