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Abstract：
METHODS: Modified Delphi Consensus and Observational Study.
OBJECTIVE: Instability in spinal tuberculosis (STB) leads to disabling spinal deformity and neurodeficit. Identifying and estimating instability remains subjective, mainly based on experience. This study aims to develop an objective scoring system to determine instability in STB.
METHODS: The study included 4 phases. (1) A panel of 10 experienced spine surgeons developed a questionnaire based on literature. (2) 68 spine surgeons from 12 countries opined on the importance of each factor in a survey. Five factors deemed important by >70% of participants were further analyzed (3) 60 representative cases of STB were analyzed for instability. A preliminary scoring system was developed, a threshold score for determining instability was derived, and (4) Results were validated.
RESULTS: All the 5 factors (\"Spine at risk\" signs, severity of vertebral body loss, Cervicothoracic/Thoracolumbar junction involvement, age ≤15, and kyphotic deformity ≥30°) considered important by >70% of participants were associated with instability and included in scoring: age ≤15 years (P-value, 0.05), cervicothoracic/thoracolumbar junction involvement (P-value, 0.028), sagittal deformity angle ratio (DAR) ≥ 15° (P-value, <.001), vertebral body loss-segmental ratio ≥.5 (P-value, <.001), and presence of spine at risk signs (P-value, <.001). A total score of ≥3/09 indicated definite instability with good sensitivity (77%) and excellent specificity (100%). Repeatability assessment showed a good agreement (.9625), and Cohen\'s kappa coefficient was strong (.809).
CONCLUSIONS: A simple objective scoring system for predicting instability in STB has been developed using 5 main factors; young age, junctional involvement, severity of the deformity, vertebral body loss, and presence of spine at risk signs.
OBJECTIVE: Instability in spinal tuberculosis (STB) leads to disabling spinal deformity and neurodeficit. Identifying and estimating instability remains subjective, mainly based on experience. This study aims to develop an objective scoring system to determine instability in STB.
METHODS: The study included 4 phases. (1) A panel of 10 experienced spine surgeons developed a questionnaire based on literature. (2) 68 spine surgeons from 12 countries opined on the importance of each factor in a survey. Five factors deemed important by >70% of participants were further analyzed (3) 60 representative cases of STB were analyzed for instability. A preliminary scoring system was developed, a threshold score for determining instability was derived, and (4) Results were validated.
RESULTS: All the 5 factors (\"Spine at risk\" signs, severity of vertebral body loss, Cervicothoracic/Thoracolumbar junction involvement, age ≤15, and kyphotic deformity ≥30°) considered important by >70% of participants were associated with instability and included in scoring: age ≤15 years (P-value, 0.05), cervicothoracic/thoracolumbar junction involvement (P-value, 0.028), sagittal deformity angle ratio (DAR) ≥ 15° (P-value, <.001), vertebral body loss-segmental ratio ≥.5 (P-value, <.001), and presence of spine at risk signs (P-value, <.001). A total score of ≥3/09 indicated definite instability with good sensitivity (77%) and excellent specificity (100%). Repeatability assessment showed a good agreement (.9625), and Cohen\'s kappa coefficient was strong (.809).
CONCLUSIONS: A simple objective scoring system for predicting instability in STB has been developed using 5 main factors; young age, junctional involvement, severity of the deformity, vertebral body loss, and presence of spine at risk signs.
摘要：
方法：改良德尔菲共识和观察性研究。
目的：脊柱结核（STB）的不稳定性会导致脊髓畸形和神经缺陷。识别和估计不稳定性仍然是主观的，主要基于经验。本研究旨在开发一种客观评分系统来确定STB的不稳定性。
方法：本研究包括4个阶段。（1）由10名经验丰富的脊柱外科医生组成的小组根据文献制定了一份问卷。（2）来自12个国家的68名脊柱外科医生在调查中认为每个因素的重要性。进一步分析了>70%的参与者认为重要的五个因素(3)分析了60例STB的代表性病例的不稳定性。开发了初步的评分系统，得出了确定不稳定性的阈值分数，(4)结果得到验证。
结果：所有5个因素（“脊柱危险”体征，椎体丢失的严重程度，颈胸/胸腰椎交界处受累，年龄≤15岁，后凸畸形≥30°）被认为重要>70％的参与者与不稳定性相关，并包括在评分中：年龄≤15岁（P值，0.05),颈胸/胸腰椎交界处受累（P值，0.028),矢状畸形角比(DAR)≥15°(P值,<.001),椎体丢失节段比≥5(P值，<.001),和存在脊柱危险体征(P值，<.001)。总分≥3/09表示明确的不稳定性，具有良好的敏感性（77％）和出色的特异性（100％）。重复性评估显示出良好的一致性(.9625)，科恩的卡帕系数很强(.809)。
结论：使用5个主要因素开发了一种用于预测STB不稳定性的简单客观评分系统；年龄小，交界处的参与，畸形的严重程度，椎体丢失，和脊柱的危险迹象。
目的：脊柱结核（STB）的不稳定性会导致脊髓畸形和神经缺陷。识别和估计不稳定性仍然是主观的，主要基于经验。本研究旨在开发一种客观评分系统来确定STB的不稳定性。
方法：本研究包括4个阶段。（1）由10名经验丰富的脊柱外科医生组成的小组根据文献制定了一份问卷。（2）来自12个国家的68名脊柱外科医生在调查中认为每个因素的重要性。进一步分析了>70%的参与者认为重要的五个因素(3)分析了60例STB的代表性病例的不稳定性。开发了初步的评分系统，得出了确定不稳定性的阈值分数，(4)结果得到验证。
结果：所有5个因素（“脊柱危险”体征，椎体丢失的严重程度，颈胸/胸腰椎交界处受累，年龄≤15岁，后凸畸形≥30°）被认为重要>70％的参与者与不稳定性相关，并包括在评分中：年龄≤15岁（P值，0.05),颈胸/胸腰椎交界处受累（P值，0.028),矢状畸形角比(DAR)≥15°(P值,<.001),椎体丢失节段比≥5(P值，<.001),和存在脊柱危险体征(P值，<.001)。总分≥3/09表示明确的不稳定性，具有良好的敏感性（77％）和出色的特异性（100％）。重复性评估显示出良好的一致性(.9625)，科恩的卡帕系数很强(.809)。
结论：使用5个主要因素开发了一种用于预测STB不稳定性的简单客观评分系统；年龄小，交界处的参与，畸形的严重程度，椎体丢失，和脊柱的危险迹象。
