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Background: To date, no evidence-based treatment algorithm is available for fractures of the subaxial spine. The aim of the present study was to assess and compare the management strategy for traumatic subaxial fractures among German and Dutch spine surgeons., Methods: In our web-based multicenter study, German and Dutch spine surgeons evaluated the computed tomography data of traumatic subaxial fractures (C3-C7). Supplementary case-specific information was provided. The fractures were classified using the AO spine classification. Next, 9 questions concerning the treatment algorithm were evaluated. Data were analyzed using SPSS. Statistical significance was defined as P < 0.05., Results: Ten surgeons (5/country) evaluated 31 cases (310 votes). The fractures were classified as AO type A in 37% (114 votes), type B in 50% (155 votes), and type C in 13% (41 votes). German spine surgeons had a lower threshold concerning the indication for surgical treatment (German, 94.2% vs. Netherlands, 58.1%; P < 0.05). A consensus was present for operative stabilization for type B and C injuries, but a discrepancy was found in the therapeutic algorithm for type A fractures. The most significant difference was seen in the treatment of type A2 and A3 fractures (surgery for type A2/A3 fracture: German, 92.9% vs. Netherlands, 5.3%; P < 0.05)., Conclusion: We found a consensus for the stabilization of AO type B and C fractures but country-specific differences in the treatment of type A fractures, especially for A2 and A3 fractures. Further evidence is necessary to ensure more consistent international treatment strategies., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Currently, no spinal classification system has achieved universal acceptance. Therefore, it is important to choose a reliable classification within clinical practice. The objective of this study was to determine and compare the intraobserver and interobserver agreement of the Load Sharing Classification (LSC), the Thoracolumbar Injury Classification System (TLICS), and the AOSpine Thoracolumbar Spine Injury Classification System., Methods: In this web-based intraobserver and interobserver study (www.spine.hostei.com), plain radiographs and computed tomographic scans of traumatic thoracolumbar fractures (T12-L2) were evaluated. By use of a questionnaire, fractures were classified according to the LSC, the TLICS, and the AOSpine classification. Data were analyzed with SPSS (Version 21, 76 Chicago, Illinois, USA). Intraobserver and interobserver agreement was determined by the Cohen κ. Statistical significance was defined as P < 0.05., Results: Data from 91 patients were classified twice by 7 board-certified spine surgeons. The intraobserver and interobserver reliability considering the LSC total score was noted as fair (intraobserver/interobserver reliability: κ = 0.26/0.22). Considering the resulting TLICS total score, a moderate intraobserver agreement (κ = 0.41) was noted, whereas the interobserver results presented only fair reliability (κ = 0.23). In contrast to the LSC and the TLICS, the AOSpine classification showed substantial agreement considering the fracture type (A;B;C) (intraobserver/interobserver reliability: κ = 0.71/0.61) and moderate agreement considering the fracture subtype (e.g., A0;A1;…;B1;…) (intraobserver/interobserver reliability: κ = 0.57/0.48)., Conclusion: In conclusion, the reliability of the AOSpine fracture classification is superior to the TLICS and the LSC. Therefore, this classification system could best be applied within clinical practice., (Copyright © 2018 Elsevier Inc. All rights reserved.)