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2. Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System

Author

Mark J. Lambrechts, Gregory D. Schroeder, Brian A. Karamian, Jose A. Canseco, F. Cumhur Oner, Lorin M. Benneker, Richard J. Bransford, Frank Kandziora, Shanmuganathan Rajasekaran, Mohammad El-Sharkawi, Rishi Kanna, Andrei Fernandes Joaquim, Klaus Schnake, Christopher K. Kepler, Alexander R. Vaccaro, Dewan Asif, Sachin Borkar, Joseph Bakar, Slavisa Zagorac, Welege Wimalachandra, Oleksandr Garashchuk, Francisco Verdu-Lopez, Giorgio Lofrese, Pragnesh Bhatt, Oke Obadaseraye, Axel Partenheimer, Marion Riehle, Eugen Cesar Popescu, Christian Konrads, Nur Aida Faruk Senan, Adetunji Toluse, Nuno Neves, Takahiro Sunami, Bart Kuipers, Jayakumar Subbiah, Anas Dyab, Peter Loughenbury, Derek Cawley, René Schmidt, Loya Kumar, Farhan Karim, Zacharia Silk, Michele Parolin, Hisco Robijn, Al Kalbani, Ricky Rasschaert, Christian Müller, Marc Nieuwenhuijse, Selim Ayhan, Shay Menachem, Sarvdeep Dhatt, Nasser Khan, Subramaniam Haribabu, Moses Kimani, Olger Alarcon, Nnaemeka Alor, Dinesh Iyer, Michal Ziga, Konstantinos Gousias, Gisela Murray, Michel Triffaux, Sebastian Hartmann, Sung-Joo Yuh, Siegmund Lang, Kyaw Linn, Charanjit Singh Dhillon, Waeel Hamouda, Stefano Carnesecchi, Vishal Kumar, Lady Lozano Cari, Gyanendra Shah, Furuya Takeo, Federico Sartor, Fernando Gonzalez, Hitesh Dabasia, Wongthawat Liawrungrueang, Lincoln Liu, Younes El Moudni, Ratko Yurak, Héctor Aceituno, Madhivanan Karthigeyan, Andreas Demetriades, Sathish Muthu, Matti Scholz, Wael Alsammak, Komal Chandrachari, Khoh Phaik Shan, Sokol Trungu, Joost Dejaegher, Omar Marroquin, Moisa Horatiu Alexandru, Máximo-Alberto Diez-Ulloa, Paulo Pereira, Claudio Bernucci, Christian Hohaus, Miltiadis Georgiopoulos, Annika Heuer, Ahmed Arieff Atan, Mark Murerwa, Richard Lindtner, Manjul Tripathi, Huynh Hieu Kim, Ahmed Hassan, Norah Foster, Amanda O’Halloran, Koroush Kabir, Mario Ganau, Daniel Cruz, Amin Henine, Jeronimo Milano, Abeid Mbarak, Arnaldo Sousa, Satyashiva Munjal, Mahmoud Alkharsawi, Muhammad Mirza, Parmenion Tsitsopoulos, Fon-Yih Tsuang, Oliver Risenbeck, Arun-Kumar Viswanadha, Samer Samy, David Orosco, Gerardo Zambito-Brondo, Nauman Chaudhry, Luis Marquez, Jacob Lepard, Juan Muñoz, Stipe Corluka, Soh Reuben, Ariel Kaen, Nishanth Ampar, Sebastien Bigdon, Damián Caba, Francisco De Miranda, Loren Lay, Ivan Marintschev, Mohammed Imran, Sandeep Mohindra, Naga Raju Reddycherla, Pedro Bazán, Abduljabbar Alhammoud, Iain Feeley, Konstantinos Margetis, Alexander Durst, Ashok Kumar Jani, Rian Souza Vieira, Felipe Santos, Joshua Karlin, Nicola Montemurro, Sergey Mlyavykh, Brian Sonkwe, Darko Perovic, Juan Lourido, Alessandro Ramieri, Eduardo Laos, Uri Hadesberg, Andrei-Stefan Iencean, Pedro Neves, Eduardo Bertolini, Naresh Kumar, Philippe Bancel, Bishnu Sharma, John Koerner, Eloy Rusafa Neto, Nima Ostadrahimi, Olga Morillo, Kumar Rakesh, Andreas Morakis, Amauri Godinho, P. Keerthivasan, Richard Menger, Louis Carius, Rajesh Bahadur Lakhey, Ehab Shiban, Vishal Borse, Elizabeth Boudreau, Gabriel Lacerda, Paterakis Konstantinos, Mubder Mohammed Saeed, Toivo Hasheela, Susana Núñez Pereira, Jay Reidler, Nimrod Rahamimov, Mikolaj Zimny, Devi Prakash Tokala, Hossein Elgafy, Ketan Badani, Bing Wui Ng, Cesar Sosa Juarez, Thomas Repantis, Ignacio Fernández-Bances, John Kleimeyer, Nicolas Lauper, Luis María Romero-Muñoz, Ayodeji Yusuf, Zdenek Klez, John Afolayan, Joost Rutges, Alon Grundshtein, Rafal Zaluski, Stavros I. Stavridis, Takeshi Aoyama, Petr Vachata, Wiktor Urbanski, Martin Tejeda, Luis Muñiz, Susan Karanja, Antonio Martín-Benlloch, Heiller Torres, Chee-Huan Pan, Luis Duchén, Yuki Fujioka, Meric Enercan, Mauro Pluderi, Catalin Majer, and Vijay Kamath

Subjects
orthopedic spine surgeon, AO Spine, upper cervical spine, reproducibility, neurosurgeon, reliability, trauma, 610 Medicine & health, General Medicine, 610 Medizin und Gesundheit
Abstract

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

Published
2023
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