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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

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
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2. Pituitary metastasis mimicking a macroadenoma from carcinoma of the larynx: a case report

Author

Zafer Kocak, Murat Caloglu, Fusun Tokatli, Latife Doganay, Kilincer C, and Uzal Mc

Subjects
Male, Cancer Research, Pituitary gland, Pathology, medicine.medical_specialty, Pituitary neoplasm, Metastasis, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Pituitary adenoma, medicine, Carcinoma, Humans, Pituitary Neoplasms, 030223 otorhinolaryngology, Laryngeal Neoplasms, business.industry, Cancer, General Medicine, Laryngeal Neoplasm, Middle Aged, medicine.disease, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Carcinoma, Squamous Cell, Differential diagnosis, business
Abstract

Metastatic tumors of the pituitary gland are not commonly diagnosed during life in cancer patients. The occurrence of symptomatic lesions is also very unusual and difficult to differentiate clinically and radiologically from pituitary adenomas. Furthermore, a single intrasellar metastasis from laryngeal carcinoma mimicking a pituitary adenoma is an extremely rare pathological finding. We report on the clinical, radiological, and pathological findings in a patient with laryngeal carcinoma who had a symptomatic solitary pituitary gland metastasis that was recognized antemortem.

Published
2002

3. Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

Author

Canseco, Jose A, Schroeder, Gregory D, Patel, Parthik D, Grasso, Giovanni, Chang, Michael, Kandziora, Frank, Vialle, Emiliano N, Oner, F Cumhur, Schnake, Klaus J, Dvorak, Marcel F, Chapman, Jens R, Benneker, Lorin M, Rajasekaran, Shanmuganathan, Kepler, Christopher K, Vaccaro, Alexander R, Abdelgawaad, Ahmed, Abdul, Waheed, Abdulsalam, Asmatullah, Abeid, Mbarak, Ackshota, Nissim, Acosta, Olga, Akman, Yunus, Aldahamsheh, Osama, Alhammoud, Abduljabbar, Aleixo, Hugo, Alexander, Hamish, Alkharsawi, Mahmoud, Alsammak, Wael, Amadou, Hassame, Amin, Mohamad, Arbatin, Jose, Atan, Ahmad, Athanasiou, Alkinoos, Bas, Paloma, Bazan, Pedro, Benzakour, Thami, Benzarti, Sofien, Bernucci, Claudiio, Bosco, Aju, Butler, Joseph, Castillo, Alejandro, Cawley, Derek, Chek, Wong, Chen, John, Cheng, Christina, Cheung, Jason, Chong, Chun, Corluka, Stipe, Corredor, Jose, Costa, Bruno, Curri, Cloe, Dawoud, Ahmed, Delgado- Fernandez, Juan, Demiroz, Serdar, Desai, Ankit, Diez-Ulloa, Maximo, Dimas, Noe, Diniz, Sara, Direito-Santos, Bruno, Duerinck, Johnny, El- Hewala, Tarek, El-Shamly, Mahmoud, El-Sharkawi, Mohammed, Espinosa, Guillermo, Estefan, Martin, Fang, Taolin, Fernandes, Mauro, Fernandez, Norbert, Ferreira, Marcus, Figueiredo, Alfredo, Fiorenza, Vito, Francis, Jibin, Franz, Seibert, Freedman, Brett, Fu, Lingjie, Fuego, Segundo, Gahlot, Nitesh, Ganau, Mario, Garcia-Pallero, Maria, Garg, Bhavuk, Gidvani, Sandeep, Giera, Bjoern, Godinho, Amauri, Goni, Morshed, Gonzalez, Maria, Gopalakrishnan, Dilip, Grin, Andrey, Grozman, Samuel, Gruenberg, Marcel, Grundshtein, Alon, Guasque, Joana, Guerra, Oscar, Guiroy, Alfredo, Hackla, Shafiq, Harris, Colin, Harrop, James, Hassan, Waqar, Henine, Amin, Hickman, Zachary, Igualada, Cristina, James, Andrew, Jetjumnong, Chumpon, Kaen, Ariel, Karmacharya, Balgopal, Kilincer, Cumur, Klezl, Zdenek, Koerner, John, Konrads, Christian, Krappel, Ferdinand, Kruyt, Moyo, Krywinski, Fernando, Kundangar, Raghuraj, Landriel, Federico, Lindtner, Richard, Linhares, Daniela, Llombart-Blanco, Rafael, Lopez, William, Lotan, Raphael, Lourido, Juan, Luna, Luis, Magashi, Tijjani, Majer, Catalin, Mandizvidza, Valentine, Manilha, Rui, Mannara, Francisco, Margetis, Konstantinos, Medina, Fabrico, Milano, Jeronimo, Miyakoshi, Naohisa, Moisa, Horatiu, Montemurro, Nicola, Montoya, Juan, Morais, Joao, Morande, Sebastian, Msuya, Salim, Mubarak, Mohamed, Mulbah, Robert, Murugan, Yuvaraja, Nacer, Mansouri, Neves, Nuno, Nicassio, Nicola, Niemeier, Thomas, Olorunsogo, Mejabi, Oner, F. C., Orosco, David, Ozdener, Kubilay, Paez, Rodolfo, Panchal, Ripul, Paterakis, Konstantinos, Pemovska, Emilija, Pereira, Paulo, Perovic, Darko, Perozo, Jose, Pershin, Andrey, Phedy, Phedy, Picazo, David, Pitti, Fernando, Platz, Uwe, Pluderi, Mauro, Ponnusamy, Gunasaeelan, Popescu, Eugen, Ramakrishnan, Selvaraj, Ramieri, Alessandro, Rebholz, Brandon, Ricciadri, Guillermo, Ricciardi, Daniel, Robinson, Yohan, Rodriguez, Luis, Rogrigues-Pinto, Ricardo, Romero, Itati, Rosas, Ronald, Russo, Salvatore, Rutges, Joost, Sartor, Federico, Schroeder, Gregory, Shariati, Babak, Sharma, Jeevan, Shoaib, Mahmoud, Smith, Sean, Sorimachi, Yasunori, Sribastav, Shilanant, Steiner, Craig, Subbiah, Jayakumar, Suramanian, Panchu, Suri, Tarun, Tannoury, Chadi, Tokala, Devi, Toluse, Adetunji, Ungurean, Victor, Vaccaro, Alexander, Vahl, Joachim, Valacco, Marcelo, Valdez, Cristian, Vernengo-Lezica, Alejo, Veroni, Andrea, Vieira, Rian, Viswanadha, Arun, Wagner, Scott, Wamae, David, Weening, Alexander, Weidert, Simon, Wu, Wen-Tien, Wu, Meng-Huang, Yuan, Haifeng, Yuh, Sung-Joo, Yurac, Ratko, Zarate- Kalfopulos, Baron, Ziabrov, Alesksei, Zubairi, Akbar, AO Spine Cervical Classification Validation Group, Canseco, Jose A, Schroeder, Gregory D, Patel, Parthik D, Grasso, Giovanni, Chang, Michael, Kandziora, Frank, Vialle, Emiliano N, Oner, F Cumhur, Schnake, Klaus J, Dvorak, Marcel F, Chapman, Jens R, Benneker, Lorin M, Rajasekaran, Shanmuganathan, Kepler, Christopher K, Vaccaro, Alexander R, Canseco J.A., Schroeder G.D., Patel P.D., Grasso G., Chang M., 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., 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., 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., Ricciadri G., Ricciardi D., Robinson Y., Rodriguez L., Rogrigues-Pinto R., Romero I., Rosas R., Russo S., Rutges J., Sartor F., Schroeder G., Shariati B., Sharma J., Shoaib M., Smith S., Sorimachi Y., Sribastav S., Steiner C., Subbiah J., Suramanian P., Suri T., Tannoury C., Tokala D., Toluse A., Ungurean V., Vaccaro A., Vahl J., Valacco M., Valdez C., Vernengo-Lezica A., Veroni A., Vieira R., Viswanadha A., Wagner S., Wamae D., Weening A., Weidert S., Wu W.-T., Wu M.-H., Yuan H., Yuh S.-J., Yurac R., Zarate-Kalfopulos B., Ziabrov A., Zubairi A., Surgical clinical sciences, Neuroprotection & Neuromodulation, and Neurosurgery

Subjects
Cervical spine, Joint dislocations, Neck injuries, Spinal diseases, Spinal injuries, Trauma, medicine.medical_specialty, Facet (geometry), Neck injurie, Neuroscience(all), 610 Medicine & health, Experiential learning, Joint dislocation, 03 medical and health sciences, 0302 clinical medicine, Spinal disease, medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Surgeons, Validation group, Spinal injurie, business.industry, Spine.cervical, medicine.disease, Preference, Spinal Fusion, Cervical Vertebrae, Physical therapy, Surgery, Neurosurgery, Anterior approach, business, 030217 neurology & neurosurgery
Abstract

Purpose The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon’s geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. Methods A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. Results A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. Conclusion More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.

Published
2020
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