《Table 4 Intra-rater reliability for vertebral fracture classifications shown as kappa value (asympt

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《Inter-and intra-rater reliability of vertebral fracture classifications in the Swedish fracture register》

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1Ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis.C:Cervical vertebra；L:Lumbar vertebra；Th:Thoracic vertebra.

In the discussions to decide a gold standard some of the common problems that came up were disagreement whether the example image，description text or the assumed injury mechanism should take priority.Classifications that involve injury to ligaments also created uncertainty among the raters in cases in which no MRI were provided.Still MRI is generally not necessary for thoracolumbar fractures[22]and is not always available for cervical fractures.From the results it is apparent that thoracolumbar B-type injuries may be the most difficult to classify（Table 2）.This is not surprising since this corresponds to our clinical experience；to determine whether there is a rupture of the posterior ligament complex is not always easy.