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
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
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
  1. xxx represents the relevant ICD-10 code
  2. n/a not available