Abstract: Objective To compare the inter- and intra-observer reliability of the GATA and SMU classification systems for spinal
tuberculosis and assess the clinical value of SMU classification. Methods One hundred patients with spinal tuberculosis
treated in our hospital from January 2004 to December 2011 were randomly selected for analysis, including 54 males and 46
females with a mean age of 45 years (range, 16- 68 years). All the patients had X-ray, CT and MRI examinations. Five observers
experienced in spinal tuberculosis independently assigned the classification using the GATA and SMU classification systems,
and the assignment was repeated 3 months later to test its reproducibility. Kappa value was used to determine the intra- and
inter-observer reliability. Results For GATA and SMU classification systems, the inter-observer percentage of agreement
averaged (59.9±4.84)% (κ=0.412±0.058) and (81.6±6.06)% (κ=0.753±0.068), and the intra-observer percentage of agreement was
(75.6 ± 5.27)% (κ=0.624 ± 0.078) and (89.8 ± 2.28)% (κ=0.862 ± 0.037), respectively. Conclusion The SMU classification system of
spinal tuberculosis has a higher inter-observer and intra-observer reliability than the GATA classification system, but its
clinical value needs to be further tested in future clinical trials.