Table 1.
Triage hierarchy for spinal conditions requiring surgical intervention (by consensus of the Singapore Spine Society)
| Triage category | Spinal conditions and considerations |
|---|---|
| Urgent | - Progressive or severe neurological deficit due to neurologic compression resulting from: |
| - Trauma | |
| - Disc herniation, especially if resulting in cauda equina syndrome | |
| - Infection (e.g., epidural abscesses) | |
| - Tumor | |
| - Spinal instability from any cause at risk of causing neurological injury (e.g., TLICS score ≥4 [23], SINS score ≥13 [24])a) | |
| - Surgical site infections | |
| Semi-urgent | - Myelopathy due to spinal stenosis with recent or rapid deterioration |
| - Tumors causing neurological compromise or spinal instability (SINS score >6) in cases that do not meet above urgent criteria | |
| - Infections yet to cause neurological deficit/spinal instability, but with inadequate response to pharmacological treatment | |
| - Spinal conditions causing intractable pain or severe functional limitations that have failed conservative management (to consider day procedures such as nerve root blocks, endoscopy, or microdiscectomy where appropriate) | |
| Elective | - Myelopathy due to spinal stenosis with neither recent nor rapid deterioration |
| - Chronic and persistent neurological deficit due to neurological compression, that does not already fall into the above categoriesb) | |
| - Spondylolisthesis, spinal stenosis, or any degenerative spinal conditions that can be managed conservatively (at least for the duration of the crisis)b) | |
| - Deformity corrections (e.g., scoliosis, kyphosis, flatback syndrome) | |
| - Revision surgery that does not fall into the above categories |
TLICS, Thoracolumbar Injury Classification and Severity; SINS, Spinal Instability Neoplastic Score.
a)
Tumor cases are considered urgent if the following criteria are met: (1) present neurology no worse than the American Spinal Injury Association [25] C (2) prognosis >1 year. If these criteria are not met, and the patient remains a surgical candidate, then the case is considered semi-urgent.
b)
May consider up triaging to semi-urgent if condition can be effectively treated by day procedures such as nerve root blocks, endoscopy or microdiscectomy, but not to take precedence over any urgent or semi-urgent cases already defined above.