The Global Spine Care Initiative: classification system for spine-related concerns

Scott Haldeman, Claire D. Johnson, Roger Chou, Margareta Nordin, Pierre Côté, Eric L. Hurwitz, Bart N. Green, Deborah Kopansky-Giles, Christine Cedraschi, Ellen Aartun, Emre Acaroğlu, Arthur Ameis, Selim Ayhan, Fiona Blyth, David Borenstein, O’Dane D. Brady, Fereydoun Davatchi, Christine Goertz, Najia Hajjaj-Hassouni, Jan HartvigsenMaria Hondras, Nadège Lemeunier, John Mayer, Silvano Mior, Tiro Mmopelwa, Michael Modic, Rajani Mullerpatan, Lillian Mwaniki, Madeleine Ngandeu-Singwe, Geoff Outerbridge, Kristi Randhawa, Erkin Sönmez, Carlos Torres, Paola Torres, William Watters, Hainan Yu

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Purpose: The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. Methods: Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. Results: Thirty-six experts from 15 countries participated. After the second round, there was 95% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0); mild symptoms (i.e., neck or back pain) but no interference with activities (class I); moderate or severe symptoms with interference of activities (class II); spine-related neurological signs or symptoms (class III); severe bony spine deformity, trauma or pathology (class IV); and spine-related symptoms or destructive lesions associated with systemic pathology (class V). Subclasses for each major class included chronicity and severity when different interventions were anticipated or recommended. Conclusions: An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)889-900
Number of pages12
JournalEuropean Spine Journal
StatePublished - Sep 1 2018


  • Back pain
  • Critical pathways
  • Delphi technique
  • Neck pain
  • Spinal diseases

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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