Spine scores and calculators
12 spine instruments, grouped by what they do. Each carries its scoring formula in full, published clinically important thresholds where they exist, and its copyright status.
Conditions covered
Acute low back pain · Adolescent idiopathic scoliosis · Adult degenerative scoliosis · Blunt cervical spine trauma · Burst fracture · Cervical radiculopathy · Cervical spine fracture · Cervical spondylosis · Chance fracture · Chronic low back pain · Chronic neck pain · Chronic pain · Congenital scoliosis · Degenerative spondylolisthesis · Fibromyalgia · Isthmic spondylolisthesis · Low back pain · Lumbar disc herniation · Lumbar spinal stenosis · Multiple myeloma of the spine · Neck injury · Neck pain · Neuromuscular scoliosis · Pathological vertebral fracture · Persistent musculoskeletal pain · Posterior ligamentous complex injury · Primary spinal tumour · Scoliosis · Spinal cord injury · Spinal metastasis · Spondylolisthesis · Spondylolysis · Spondyloptosis · Thoracolumbar fracture · Vertebral metastatic disease · Whiplash-associated disorder
Patient-reported outcome measure6
- Modified Oswestry10 itemsModified Oswestry Low Back Pain Disability QuestionnaireThe Modified Oswestry Low Back Pain Disability Questionnaire is the Oswestry with one change — an employment and homemaking section replaces the sex life section — scored the same way: ten sections rated 0 to 5, added and doubled to give a percentage from 0% (no disability) to 100% (maximum disability).
- NDI10 itemsNeck Disability IndexThe Neck Disability Index measures how far neck pain restricts ten everyday activities, scoring each section from 0 to 5 for a raw total out of 50, which is commonly doubled and reported as a percentage from 0% (no disability) to 100% (complete disability).
- ODI10 itemsOswestry Disability IndexThe Oswestry Disability Index measures how far low back pain restricts ten everyday activities, scoring each section from 0 to 5 and expressing the total as a percentage from 0% (no disability) to 100% (maximum disability).
- PSEQ10 itemsPain Self-Efficacy QuestionnaireThe Pain Self-Efficacy Questionnaire measures how confident a person is in carrying out activities despite their pain, scoring ten statements from 0 to 6 for a total of 0 to 60, where higher scores indicate stronger self-efficacy and 40 or more is the commonly cited threshold for a good functional prognosis.
- RMDQ24 itemsRoland-Morris Disability QuestionnaireThe Roland-Morris Disability Questionnaire measures physical disability from low back pain by counting how many of 24 statements a patient agrees with, giving a score from 0 (no disability) to 24 (maximum disability).
- STarT Back9 itemsSTarT Back Screening ToolThe STarT Back Screening Tool stratifies patients with low back pain into low, medium and high risk of persistent disabling pain using nine items, of which five form a psychosocial subscale, so that treatment can be matched to risk rather than given uniformly.
Clinical calculator4
- Cobb AngleCobb Angle for ScoliosisThe Cobb angle measures the magnitude of a scoliotic curve as the angle between the superior endplate of the upper end vertebra and the inferior endplate of the lower end vertebra, where 10 degrees or more defines scoliosis and 45 to 50 degrees is the conventional threshold for discussing surgery.
- MeyerdingMeyerding Classification of SpondylolisthesisThe Meyerding classification grades spondylolisthesis by the percentage of anterior translation of one vertebral body over the one below, measured on a standing lateral radiograph, from grade I at 25% or less through to grade V, spondyloptosis, beyond 100%.
- SINS6 itemsSpinal Instability Neoplastic ScoreThe Spinal Instability Neoplastic Score grades the mechanical stability of a spine affected by tumour by adding six components — location, mechanical pain, lesion quality, alignment, vertebral body collapse and posterolateral involvement — to a total from 0 to 18, where 0 to 6 is stable, 7 to 12 is indeterminate and 13 to 18 is unstable, and any total of 7 or more warrants surgical consultation.
- TLICS3 itemsThoracolumbar Injury Classification and Severity ScoreTLICS grades a thoracolumbar injury by adding three components — injury morphology scored 1 to 4, integrity of the posterior ligamentous complex scored 0 to 3, and neurological status scored 0 to 3 — giving a total from 1 to 10 in which 3 or less favours non-operative treatment, 4 is left to the surgeon’s discretion and 5 or more favours surgery.
Clinical decision rule2
- Canadian C-Spine Rule3 itemsCanadian C-Spine RuleThe Canadian C-Spine Rule decides whether an alert, stable blunt trauma patient needs cervical spine radiography through three sequential steps — high-risk factors, low-risk factors, and the ability to actively rotate the neck 45 degrees each way — with a reported sensitivity of about 99% for clinically significant injury.
- NEXUS5 itemsNEXUS Low-Risk Criteria for Cervical Spine ImagingThe NEXUS low-risk criteria allow the cervical spine to be cleared without imaging after blunt trauma when all five findings are absent — midline cervical tenderness, focal neurological deficit, altered alertness, intoxication and a distracting injury — with a reported sensitivity of about 99% for clinically significant injury.