Top

Published in:

01-07-2016 | Original Article

AOSpine subaxial cervical spine injury classification system

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

Published in: European Spine Journal | Issue 7/2016

Abstract

Purpose

This project describes a morphology-based subaxial cervical spine traumatic injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes.

Methods

A subaxial cervical spine injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients (κ) were calculated for intraobserver and interobserver reliability.

Results

The classification system is based on three injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all injury subtypes (κ = 0.75 and 0.64, respectively).

Conclusions

The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.

Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP (1982) A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 7:1–27CrossRefPubMed

Harris JH Jr, Edeiken-Monroe B, Kopaniky DR (1986) A practical classification of acute cervical spine injuries. Orthop Clin North Am 17:15–30PubMed

Holdsworth F (1970) Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 52:1534–1551PubMed

Aebi M, Nazarian S (1987) Classification of injuries of the cervical spine. Der Orthopade 16:27–36PubMed

Blauth MKA, Mair G, Schmid R, Reinhold M, Rieger M (2007) Classification of injuries of the subaxial cervical spine. In: Aebi MAV, Webb JK (eds) AO spine manual: clinical applications. Thieme, Stuttgart, pp 21–38

Bohler L (1951) Die Technik der Knochenbruchbehandlung. Maudrich, Wien

van Middendorp JJ, Audige L, Hanson B, Chapman JR, Hosman AJ (2010) What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications. Euro Spine J Off Publ Eur Spine Soc Euro Spinal Deformity Soc Euro Sect Cerv Spine Res Soc 19:1238–1249. doi:10.1007/s00586-010-1415-9 CrossRef

Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA, Anderson P, Harrop J, Oner FC, Arnold P, Fehlings M, Hedlund R, Madrazo I, Rechtine G, Aarabi B, Shainline M, Spine Trauma Study G (2007) The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine 32:2365–2374. doi:10.1097/BRS.0b013e3181557b92 CrossRefPubMed

Stone AT, Bransford RJ, Lee MJ, Vilela MD, Bellabarba C, Anderson PA, Agel J (2010) Reliability of classification systems for subaxial cervical injuries. Evidence-Based Spine-Care J 1:19–26. doi:10.1055/s-0030-1267064 CrossRef

10.

van Middendorp JJ, Audige L, Bartels RH, Bolger C, Deverall H, Dhoke P, Diekerhof CH, Govaert GA, Guimera V, Koller H, Morris SA, Setiobudi T, Hosman AJ (2013) The Subaxial Cervical Spine Injury Classification System: an external agreement validation study. Spine J Off J North Am Spine Soc. doi:10.1016/j.spinee.2013.02.040

11.

Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L, Injury AOSC, Trauma Knowledge F (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine 38:2028–2037. doi:10.1097/BRS.0b013e3182a8a381 CrossRefPubMed

12.

Audige L, Bhandari M, Hanson B, Kellam J (2005) A concept for the validation of fracture classifications. J Orthop Trauma 19:401–406PubMed

13.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed

14.

Spector LR, Kim DH, Affonso J, Albert TJ, Hilibrand AS, Vaccaro AR (2006) Use of computed tomography to predict failure of nonoperative treatment of unilateral facet fractures of the cervical spine. Spine 31:2827–2835. doi:10.1097/01.brs.0000245864.72372.8f CrossRefPubMed

15.

Vaccaro AR, Falatyn SP, Flanders AE, Balderston RA, Northrup BE, Cotler JM (1999) Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations. Spine 24:1210–1217CrossRefPubMed

16.

Slongo T, Audige L, Clavert JM, Lutz N, Frick S, Hunter J (2007) The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study. J Pediatr Orthop 27:171–180. doi:10.1097/01.bpb.0000248569.43251.f9 CrossRefPubMed

17.

Slongo T, Audige L, Schlickewei W, Clavert JM, Hunter J, International Association for Pediatric T (2006) Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology. J Pediatr Orthop 26:43–49. doi:10.1097/01.bpo.0000187989.64021.ml CrossRef

18.

Bailitz J, Starr F, Beecroft M, Bankoff J, Roberts R, Bokhari F, Joseph K, Wiley D, Dennis A, Gilkey S, Erickson P, Raksin P, Nagy K (2009) CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma 66:1605–1609. doi:10.1097/TA.0b013e3181a5b0cc CrossRefPubMed

19.

LeBlang SD, Nunez DB, Jr. (1999) Helical CT of cervical spine and soft tissue injuries of the neck. Radiologic clinics of North America 37:515-532, v-vi

20.

Vaccaro AR, Rihn JA, Saravanja D, Anderson DG, Hilibrand AS, Albert TJ, Fehlings MG, Morrison W, Flanders AE, France JC, Arnold P, Anderson PA, Friel B, Malfair D, Street J, Kwon B, Paquette S, Boyd M, Dvorak MF, Fisher C (2009) Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine 34:E841–E847. doi:10.1097/BRS.0b013e3181bd11be CrossRefPubMed

21.

Oner FC, Wood KB, Smith JS, Shaffrey CI (2010) Therapeutic decision making in thoracolumbar spine trauma. Spine 35:S235–S244. doi:10.1097/BRS.0b013e3181f32734 CrossRefPubMed

22.

Nadeau M, McLachlin SD, Bailey SI, Gurr KR, Dunning CE, Bailey CS (2012) A biomechanical assessment of soft-tissue damage in the cervical spine following a unilateral facet injury. J Bone Joint Surg Am 94:e156. doi:10.2106/JBJS.K.00694 CrossRefPubMed

23.

Rasoulinejad P, McLachlin SD, Bailey SI, Gurr KR, Bailey CS, Dunning CE (2012) The importance of the posterior osteoligamentous complex to subaxial cervical spine stability in relation to a unilateral facet injury. Spine J Off J North Am Spine Soc 12:590–595. doi:10.1016/j.spinee.2012.07.003 CrossRef

24.

Ivancic PC, Pearson AM, Tominaga Y, Simpson AK, Yue JJ, Panjabi MM (2007) Mechanism of cervical spinal cord injury during bilateral facet dislocation. Spine 32:2467–2473. doi:10.1097/BRS.0b013e3181573b67 CrossRefPubMed

25.

Wilson JR, Vaccaro A, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R, Okonkwo DO, Fehlings MG (2013) The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. Spine 38:97–103. doi:10.1097/BRS.0b013e31826e2b91 CrossRefPubMed

Title: AOSpine subaxial cervical spine injury classification system
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
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 7/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-3831-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

AOSpine subaxial cervical spine injury classification system

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2016

Prevalence of axial symptoms after posterior cervical decompression: a meta-analysis

Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (–) cervical ossification of the posterior longitudinal ligament

Publication rate of paper and podium presentations from the European Section of the Cervical Spine Research Society Annual Meeting

Surgical planning, manufacturing and implantation of an individualized cervical fusion titanium cage using patient-specific data

Esophageal perforation after anterior cervical surgery: a review of the literature for over half a century with a demonstrative case and a proposed novel algorithm