Table 2 The GSCI classification system for spine-related concerns. Reprinted with permission from the World Spine Care
| Class | Subclass |
|---|---|
| Class 0: No or minimal spine-related symptoms, potential for prevention, no interference with function or activities of daily living, no neurological deficits, no severe pathology |
Class 0a: No evident risk factors for a spine-related disorder or pain Class 0b: One or more risk factors for a spine-related disorder or pain |
| Class I: Spine-related symptoms, no or minimal interference with function or activities of daily living, no neurological deficits, no severe pathology |
Class Ia: Acute or subacute, mild pain Class Ib: Chronic or recurrent, mild pain |
| Class II: Spine-related symptoms, interference with function or activities of daily living, no neurological deficits, no severe pathology |
Class IIa: Acute or subacute, moderate pain Class IIb: Chronic or recurrent, moderate pain Class IIc: Acute or subacute, severe pain Class IId: Chronic or recurrent, severe pain |
| Class III: Spine-related symptoms with neurological symptoms or deficits, interference with function or activities of daily living, focal pathology compromising neural structures |
Class IIIa: Minor and non-progressive Class IIIb: Acute, major, and progressive Class IIIc: Chronic and stable |
| Class IV: Spine-related symptoms with stable, severe deformity, with or without interference with function or activities of daily living, with or without neurological deficits |
Class IVa: Stable spine pathology, no correlation with symptoms Class IVb: Acute or chronic spine pathology with correlation to symptoms |
| Class V: Serious spine-related symptoms with severe or systemic pathology, interference with function or activities of daily living, with or without neurological deficits |
Class Va: Severe, acute spinal pathology, requires immediate intervention (emergency) Class Vb: Severe, slowly progressive spinal pathology, requires intervention (non-emergency) Class Vc: Spine symptoms originating from non-spine pathology, requires immediate intervention (emergency) |
- Note: A person may present with more than one spine-related concern. Each region with a concern should receive a class. Therefore, a person with multiple concerns may be classified in more than one class (e.g., one class for neck pain and a different class for low back pain). If a patient presents with diffuse non-focal pain, it should be listed as such and given a classification compatible with its severity, chronicity, and functional interference. Any class could be considered an option, and the health care provider may choose to use or not use any class depending on the social, environmental, level or resources, or clinical setting
- Legend
- Activities of daily living (ADL) = a set of everyday tasks which is required for personal self-care and independent living. The most common measure of ADL is the Katz Activities of Daily Living Scale that measures bathing, dressing, toileting, transferring, continence, and feeding
- Acute or subacute = < 3 months
- Chronic or recurrent = > 3 months
- Mild pain = Numeric pain scale 2 to 4/10 or National Institutes of Health (NIH) Pain Consortium Impact Classification Scores [33] “mild” (score 8–27) pain (i.e., 8 = least impact) to 50 = greatest impact)
- Moderate pain = Numeric pain scale 5 to 7/10 or National Institutes of Health (NIH) Pain Consortium Impact Classification Scores [33] “moderate” (score 28–34) pain (i.e., 8 = least impact) to 50 = greatest impact)
- Prevention = individual and population health intervention measures to reduce or prevent injury and spinal disorders. These may include occupational injury prevention, social policy (e.g., no-fault insurance), prenatal care (e.g., nutrition to prevent spina bifida), osteoporosis screening, exercise programs, etc
- Progressive = increasing symptoms, pathology, or deficits
- Severe pain = Numeric pain scale 8 to 10/10 or National Institutes of Health (NIH) Pain Consortium Impact Classification Scores [33] “severe” (score >=35) pain (i.e., 8 = least impact) to 50 = greatest impact)
- Stable = unchanging and unlikely to change in the short term but may require symptomatic care
- Symptoms = spine-related symptoms: (e.g., pain, psychological symptoms, psychosocial stress, altered sensation, weakness, incoordination, incontinence, breathing difficulties)