Christopher K Kepler1, Alexander R Vaccaro1, John D Koerner1, Marcel F Dvorak2, Frank Kandziora3, Shanmuganathan Rajasekaran4, Bizhan Aarabi5, Luiz R Vialle6, Michael G Fehlings7, Gregory D Schroeder8, Maximilian Reinhold9, Klaus John Schnake10, Carlo Bellabarba11, F Cumhur Öner12. 1. Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA. 2. University of British Columbia, Vancouver, BC, Canada. 3. Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Friedberger Landstrasse 430, 60389, Frankfurt, Germany. 4. Ganga Hospital, Coimbatore, Tamil Nadu, India. 5. University of Maryland Medical Center, College Park, MD, USA. 6. Catholic University of Parana, Curitiba, Brazil. 7. University of Toronto Spine Program and Toronto Western Hospital, Toronto, ON, Canada. 8. Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA. gregdschroeder@gmail.com. 9. Klinikum Suedstadt Rostock, Department of Orthopaedic and Trauma Surgery, Suedring 81, 18059, Rostock, Germany. 10. Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstrasse 430, 60389, Frankfurt/Main, Germany. 11. Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359798, Seattle, WA, 98104, USA. 12. School of Medicine, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
Abstract
PURPOSE: The aims of this study were (1) to demonstrate the AOSpine thoracolumbar spine injury classification system can be reliably applied by an international group of surgeons and (2) to delineate those injury types which are difficult for spine surgeons to classify reliably. METHODS: A previously described classification system of thoracolumbar injuries which consists of a morphologic classification of the fracture, a grading system for the neurologic status and relevant patient-specific modifiers was applied to 25 cases by 100 spinal surgeons from across the world twice independently, in grading sessions 1 month apart. The results were analyzed for classification reliability using the Kappa coefficient (κ). RESULTS: The overall Kappa coefficient for all cases was 0.56, which represents moderate reliability. Kappa values describing interobserver agreement were 0.80 for type A injuries, 0.68 for type B injuries and 0.72 for type C injuries, all representing substantial reliability. The lowest level of agreement for specific subtypes was for fracture subtype A4 (Kappa = 0.19). Intraobserver analysis demonstrated overall average Kappa statistic for subtype grading of 0.68 also representing substantial reproducibility. CONCLUSION: In a worldwide sample of spinal surgeons without previous exposure to the recently described AOSpine Thoracolumbar Spine Injury Classification System, we demonstrated moderate interobserver and substantial intraobserver reliability. These results suggest that most spine surgeons can reliably apply this system to spine trauma patients as or more reliably than previously described systems.
PURPOSE: The aims of this study were (1) to demonstrate the AOSpine thoracolumbar spine injury classification system can be reliably applied by an international group of surgeons and (2) to delineate those injury types which are difficult for spine surgeons to classify reliably. METHODS: A previously described classification system of thoracolumbar injuries which consists of a morphologic classification of the fracture, a grading system for the neurologic status and relevant patient-specific modifiers was applied to 25 cases by 100 spinal surgeons from across the world twice independently, in grading sessions 1 month apart. The results were analyzed for classification reliability using the Kappa coefficient (κ). RESULTS: The overall Kappa coefficient for all cases was 0.56, which represents moderate reliability. Kappa values describing interobserver agreement were 0.80 for type A injuries, 0.68 for type B injuries and 0.72 for type C injuries, all representing substantial reliability. The lowest level of agreement for specific subtypes was for fracture subtype A4 (Kappa = 0.19). Intraobserver analysis demonstrated overall average Kappa statistic for subtype grading of 0.68 also representing substantial reproducibility. CONCLUSION: In a worldwide sample of spinal surgeons without previous exposure to the recently described AOSpine Thoracolumbar Spine Injury Classification System, we demonstrated moderate interobserver and substantial intraobserver reliability. These results suggest that most spine surgeons can reliably apply this system to spine traumapatients as or more reliably than previously described systems.
Authors: Jeffrey A Rihn; Nuo Yang; Charles Fisher; Davor Saravanja; Harvey Smith; William B Morrison; James Harrop; Alexander R Vacaro Journal: J Neurosurg Spine Date: 2010-04
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Authors: Henrik C Bäcker; J Turner Vosseller; Lorin Benneker; Markus Noger; Fabian Krause; Sven Hoppe; Moritz C Deml Journal: Eur Spine J Date: 2019-03-18 Impact factor: 3.134