Table 1 Review of spinal disorders 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 Standards for Chronic Low Back Pain [12, 13] | 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 |
- xxx represents the relevant ICD-10 code
- n/a not available