Juan P Cabrera1,2, Ratko Yurac3, Alfredo Guiroy4, Andrei F Joaquim5, Charles A Carazzo6, Juan J Zamorano3, Kevin P White7, Marcelo Valacco8. 1. Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile. jucabrera@udec.cl. 2. Faculty of Medicine, University of Concepción, Concepción, Chile. jucabrera@udec.cl. 3. Department of Orthopedic and Traumatology, Department of Traumatology, University del Desarrollo (UDD). Spine Unit, Clínica Alemana, Santiago, Chile. 4. Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina. 5. Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil. 6. Department of Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil. 7. ScienceRight Research Consulting, London, ON, Canada. 8. Department of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina.
Abstract
PURPOSE: A classification system was recently developed by the international association AO Spine for assessing subaxial cervical spine fractures. Significant variability exists between users of the facet component, which consists of four morphological types (F1-F4). The primary aims of this study were to assess the diagnostic accuracy and reliability of this new system's facet injury morphological classifications. METHODS: A survey consisting of 16 computed tomography (CT) scans of patients with cervical facet fractures was distributed to spine surgeon members of AO Spine Latin America. To provide a gold standard diagnosis for comparison, all 16 injuries had been classified previously by six co-authors and only were included after total consensus was achieved. Demographic and surgical practice characteristics of all respondents were analyzed, and diagnostic accuracy calculated. Inter- and intra-observer agreement rates were calculated across two survey rounds, conducted one month apart. RESULTS: A total of 135 surgeons completed both surveys, among whom the mean age was 41.6 years (range 26-71), 130 (96.3%) were men, and 83 (61.5%) were orthopedic surgeons. The mean time in practice as a spine surgeon was 9.7 years (1-30). The overall diagnostic accuracy of all responses was 65.4%. Inter-observer and intra-observer agreement rates for F1/F2/F3/F4 were 55.4%/47.6%/64.0%/94.7% and 60.0%/49.1%/58.0%/93.0%, respectively. CONCLUSION: This study evaluates the AO Spine Classification System specifically for facet injuries involving the subaxial cervical spine in a large sample of spine surgeons. There was significant variability in diagnostic accuracy for F1 through F3-type fractures, whereas almost universal agreement was achieved for F4-type injuries.
PURPOSE: A classification system was recently developed by the international association AO Spine for assessing subaxial cervical spine fractures. Significant variability exists between users of the facet component, which consists of four morphological types (F1-F4). The primary aims of this study were to assess the diagnostic accuracy and reliability of this new system's facet injury morphological classifications. METHODS: A survey consisting of 16 computed tomography (CT) scans of patients with cervical facet fractures was distributed to spine surgeon members of AO Spine Latin America. To provide a gold standard diagnosis for comparison, all 16 injuries had been classified previously by six co-authors and only were included after total consensus was achieved. Demographic and surgical practice characteristics of all respondents were analyzed, and diagnostic accuracy calculated. Inter- and intra-observer agreement rates were calculated across two survey rounds, conducted one month apart. RESULTS: A total of 135 surgeons completed both surveys, among whom the mean age was 41.6 years (range 26-71), 130 (96.3%) were men, and 83 (61.5%) were orthopedic surgeons. The mean time in practice as a spine surgeon was 9.7 years (1-30). The overall diagnostic accuracy of all responses was 65.4%. Inter-observer and intra-observer agreement rates for F1/F2/F3/F4 were 55.4%/47.6%/64.0%/94.7% and 60.0%/49.1%/58.0%/93.0%, respectively. CONCLUSION: This study evaluates the AO Spine Classification System specifically for facet injuries involving the subaxial cervical spine in a large sample of spine surgeons. There was significant variability in diagnostic accuracy for F1 through F3-type fractures, whereas almost universal agreement was achieved for F4-type injuries.
Authors: Alexander R Vaccaro; John D Koerner; Kris E Radcliff; F Cumhur Oner; Maximilian Reinhold; Klaus J Schnake; Frank Kandziora; Michael G Fehlings; Marcel F Dvorak; Bizhan Aarabi; Shanmuganathan Rajasekaran; Gregory D Schroeder; Christopher K Kepler; Luiz R Vialle Journal: Eur Spine J Date: 2015-02-26 Impact factor: 3.134
Authors: Jose A Canseco; Gregory D Schroeder; Parthik D Patel; Giovanni Grasso; Michael Chang; Frank Kandziora; Emiliano N Vialle; F Cumhur Oner; Klaus J Schnake; Marcel F Dvorak; Jens R Chapman; Lorin M Benneker; Shanmuganathan Rajasekaran; Christopher K Kepler; Alexander R Vaccaro Journal: Eur Spine J Date: 2020-07-22 Impact factor: 3.134
Authors: Leo R Spector; David H Kim; Jesse Affonso; Todd J Albert; Alan S Hilibrand; Alexander R Vaccaro Journal: Spine (Phila Pa 1976) Date: 2006-11-15 Impact factor: 3.468
Authors: Marcel F Dvorak; Charles G Fisher; Bizhan Aarabi; Mitchel B Harris; R John Hurbert; Y Raja Rampersaud; Alex Vaccaro; James S Harrop; Russ P Nockels; Ignacio N Madrazo; David Schwartz; Brian K Kwon; Yinshan Zhao; Michael G Fehlings Journal: Spine (Phila Pa 1976) Date: 2007-12-15 Impact factor: 3.468
Authors: Alexander R Vaccaro; R John Hulbert; Alpesh A Patel; Charles Fisher; Marcel Dvorak; Ronald A Lehman; Paul Anderson; James Harrop; F C Oner; Paul Arnold; Michael Fehlings; Rune Hedlund; Ignacio Madrazo; Glenn Rechtine; Bizhan Aarabi; Mike Shainline Journal: Spine (Phila Pa 1976) Date: 2007-10-01 Impact factor: 3.468