1. Establishing the Injury Severity of Subaxial Cervical Spine Trauma: Validating the Hierarchical Nature of the AO Spine Subaxial Cervical Spine Injury Classification System
- Author
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Schroeder, G. D., Canseco, J. A., Patel, P. D., Divi, S. N., Karamian, B. A., Kandziora, F., Vialle, E. N., Oner, F. C., Schnake, K. J., Dvorak, M. F., Chapman, J. R., Benneker, L. M., Rajasekaran, S., Kepler, C. K., Vaccaro, A. R., Abdelgawaad, A. S., Abdul, W., Abdulsalam, A., Abeid, M., Ackshota, N., Acosta, O., Akman, Y., Aldahamsheh, O., Alhammoud, A., Aleixo, H., Alexander, H., Alkharsawi, M., Alsammak, W., Amadou, H., Amin, M., Arbatin, J., Atan, A., Athanasiou, A., Bas, P., Bazan, P., Benzakour, T., Benzarti, S., Bernucci, C., Bosco, A., Butler, J., Castillo, A., Cawley, D., Chek, W., Chen, J., Cheng, C., Cheung, J., Chong, C., Corluka, S., Corredor, J., Costa, B., Curri, C., Dawoud, A., Delgado-Fernandez, J., Demiroz, S., Desai, A., Diez-Ulloa, M., Dimas, N., Diniz, S., Direito-Santos, B., Duerinck, J., El-Hewala, T., El-Shamly, M., El-Sharkawi, M., Espinosa, G., Estefan, M., Fang, T., Fernandes, M., Fernandez, N., Ferreira, M., Figueiredo, A., Fiorenza, V., Francis, J., Franz, S., Freedman, B., Fu, L., Fuego, S., Gahlot, N., Ganau, M., Garcia-Pallero, M., Garg, B., Gidvani, S., Giera, B., Godinho, A., Goni, M., Gonzalez, M., Gonzalez, R., Gopalakrishnan, D., Grin, A., Grozman, S., Gruenberg, M., Grundshtein, A., Guasque, J., Guerra, O., Guiroy, A., Hackla, S., Harris, C., Harrop, J., Hassan, W., Henine, A., Hickman, Z., Igualada, C., James, A., Jetjumnong, C., Kaen, A., Karmacharya, B., Kilincer, C., Klezl, Z., Koerner, J., Konrads, C., Krappel, F., Kruyt, M., Krywinski, F., Kundangar, R., Landriel, F., Lindtner, R., Linhares, D., Llombart-Blanco, R., Lopez, W., Lotan, R., Lourido, J., Luna, L., Magashi, T., Majer, C., Mandizvidza, V., Manilha, R., Mannara, F., Margetis, K., Medina, F., Milano, J., Miyakoshi, N., Moisa, H., Montemurro, N., Montoya, J., Morais, J., Morande, S., Msuya, S., Mubarak, M., Mulbah, R., Murugan, Y., Nacer, M., Neves, N., Nicassio, N., Niemeier, T., Olorunsogo, M., Orosco, D., Ozdener, K., Paez, R., Panchal, R., Paterakis, K., Pemovska, E., Pereira, P., Perovic, D., Perozo, J., Pershin, A., Phedy, P., Picazo, D., Pitti, F., Platz, U., Pluderi, M., Ponnusamy, G., Popescu, E., Ramakrishnan, S., Ramieri, A., Rebholz, B., Ricciardi, G., Ricciardi, D., Robinson, Y., Rodriguez, L., Rodrigues-Pinto, R., Romero, I., Rosas, R., Russo, S., Rutges, J., Sartor, F., Shariati, B., Sharma, J., Shoaib, M., Smith, S., Sorimachi, Y., Sribastav, S., Steiner, C., Subbiah, J., Subramanian, P., Suri, T., Tannoury, C., Tokala, D., Toluse, A., Ungurean, V., Vahl, J., Valacco, M., Valdez, C., Vernengo-Lezica, A., Veroni, A., Vieira, R., Viswanadha, A., Wagner, S., Wamae, D., Weening, A., Weidert, S., W. -T., Wu, M. -H., Wu, Yuan, H., Yuh, S. -J., Yurac, R., Zarate-Kalfopulos, B., Ziabrov, A., Zubairi, A., Surgical clinical sciences, Neuroprotection & Neuromodulation, and Neurosurgery
- Subjects
Adult ,Male ,Facet (geometry) ,medicine.medical_specialty ,Cross-sectional study ,Clinical Neurology ,610 Medicine & health ,Cervical spine injury ,cervical spine ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Injury Severity Score ,Surveys and Questionnaires ,Severity of illness ,Validation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Spinal cord injury ,Spinal Cord Injuries ,030222 orthopedics ,business.industry ,Reproducibility of Results ,AO spine subaxial cervical spine injury ,Cervical spine ,Classification system ,Injury severity score ,Trauma ,Cervical Vertebrae ,Cross-Sectional Studies ,Female ,medicine.disease ,medicine.anatomical_structure ,trauma ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Cervical vertebrae - Abstract
STUDY DESIGN Global cross-sectional survey. OBJECTIVE To validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience. SUMMARY OF BACKGROUND DATA Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: (1) injury morphology, (2) facet injury involvement, (3) neurologic status, and (4) case-specific modifiers. METHODS A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience. RESULTS A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, p:0.04), N3 (incomplete spinal cord injury, p:0.03), and M2 (critical disk herniation, p:0.04). When stratified by surgeon experience, pairwise comparison showed only 2 morphological subtypes, B1 (bony posterior tension band injury, p:0.02) and F2 (unstable facet fracture, p:0.03), and one neurologic subtype (N3, p:0.02) exhibited a significant difference in injury severity score. CONCLUSIONS The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience; and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.
- Published
- 2021