AO Spine Upper Cervical Injury Classification System: A Description and Reliability Study.

Vaccaro, Alexander R; Lambrechts, Mark J; Karamian, Brian A; Canseco, Jose A; Oner, Cumhur; Vialle, Emiliano; Rajasekaran, Shanmuganathan; Dvorak, Marcel R; Benneker, Lorin M; Kandziora, Frank; El-Sharkawi, Mohammad; Tee, Jin Wee; Bransford, Richard; Joaquim, Andrei F; Muijs, Sander Pj; Holas, Martin; Takahata, Masahiko; Ossama Hamouda, W; Kanna, Rishi M; Schnake, Klaus; ... (2022). AO Spine Upper Cervical Injury Classification System: A Description and Reliability Study. The spine journal, 22(12), pp. 2042-2049. Elsevier 10.1016/j.spinee.2022.08.005

Preview

Text 1-s2.0-S1529943022008439-main.pdf - Accepted Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (871kB) | Preview

BACKGROUND CONTEXT

Prior upper cervical spine injury classification systems have focused on injuries to the craniocervical junction (CCJ), atlas, and dens independently. However, no previous system has classified upper cervical spine injuries using a comprehensive system incorporating all injuries from the occiput to the C2-3 joint.

PURPOSE

To (1) determine the accuracy of experts at correctly classifying upper cervical spine injuries based on the recently proposed AO Spine Upper Cervical Injury Classification System (2) to determine their interobserver reliability and (3) identify the intraobserver reproducibility of the experts.

STUDY DESIGN/SETTING

International Multi-Center Survey PATIENT SAMPLE: A survey of international spine surgeons on 29 unique upper cervical spine injuries OUTCOME MEASURES: Classification accuracy, interobserver reliability, intraobserver reproducibility METHODS: Thirteen international AO Spine Knowledge Forum Trauma members participated in two live webinar-based classifications of 29 upper cervical spine injuries presented in random order, four weeks apart. Percent agreement with the gold-standard and kappa coefficients (ƙ) were calculated to determine the interobserver reliability and intraobserver reproducibility.

RESULTS

Raters demonstrated 80.8% and 82.7% accuracy with identification of the injury classification (combined location and type) on the first and second assessment, respectively. Injury classification intraobserver reproducibility was excellent (mean, [range] ƙ = 0.82 [0.58-1.00]). Excellent interobserver reliability was found for injury location (ƙ = 0.922 and ƙ= 0.912) on both assessments, while injury type was substantial (ƙ=0.689 and 0.699) on both assessments. This correlated to a substantial overall interobserver reliability (ƙ = 0.729 and 0.732).

CONCLUSION

Early phase validation demonstrated classification of upper cervical spine injuries using the AO Spine Upper Cervical Injury Classification System to be accurate, reliable, and reproducible. Greater than 80% accuracy was detected for injury classification. The intraobserver reproducibility was excellent, while the interobserver reliability was substantial.

Interest & Impact

Downloads

148 since deposited on 17 Aug 2022
90 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item