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3. 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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4. Clinical evaluation of ankle arthrodesis with Ilizarov fixation and internal fixation

Author

Piotr Morasiewicz, Maciej Dejnek, Wiktor Orzechowski, Wiktor Urbański, Mirosław Kulej, Szymon Łukasz Dragan, Szymon Feliks Dragan, and Łukasz Pawik

Subjects
Clinical, Ankle arthrodesis, Ilizarov fixation, Internal fixation, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Ankle arthrodesis may have internal or external stabilization. We assessed whether the type of stabilization after ankle arthrodesis will affect: (1) functional outcome in Foot and Ankle Ability Measure (FAAM) scale, (2) pain level, (3) period of hospitalization, (4) rate of complications. Methods We retrospectively studied 47 individuals after ankle arthrodesis with Ilizarov fixation (group 1, n = 21) and internal stabilization (group 2, n = 26) at our institution in years 2007–2015. Clinical outcomes were measure by: (1) functional outcome in FAAM scale, (2) pain level, (3) period of hospitalization, (4) rate of complications. Results Total number of complications in Ilizarov group was 13, which corresponded to 0.62 complications per patient on average. In group 2 there were 15 complications, which corresponded to 0.58 complications per patient on average. The intergroup difference in rate of complications was not statistically significant (p = 0.066). In group 1 the mean VAS pain level before treatment was 4.69 and after treatment was 1.5 (p = 0.037). In group with internal stabilization the mean VAS pain level before treatment was 4.71 and after treatment was 2.9 (p = 0.044). In group 1 the mean period of hospitalization was 5.29 days, in group 2 was 5.71 days (p = 0.517). In group 1 the mean functional outcome in FAAM scale was 79.38, in group 2 was 70.11 (p = 0.458). Conclusions Ankle arthrodesis with Ilizarov stabilization is associated with lower prevalence of VAS pain level after surgery than after internal screws stabilization. Rate of complications, FAAM functional score and period of hospitalization were not statistically significant between group 1 and 2. Clinical outcome was satisfactory in group 1 and 2, but outcomes in Ilizarov group were slightly better than after internal stabilization.

Published
2019
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5. Pedobarographic analysis of body weight distribution on the lower limbs and balance after ankle arthrodesis with Ilizarov fixation and internal fixation

Author

Piotr Morasiewicz, Grzegorz Konieczny, Maciej Dejnek, Leszek Morasiewicz, Wiktor Urbański, Mirosław Kulej, Szymon Łukasz Dragan, Szymon Feliks Dragan, and Łukasz Pawik

Subjects
Pedobarography, Body weight distribution, Balance, Ankle arthrodesis, Ilizarov fixation, Internal fixation, Medical technology, R855-855.5
Abstract

Abstract Background A number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads. Methods Retrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform. Results In group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant. Conclusions Balance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients’ balance.

Published
2018
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