[Rheumatoid instability in the cervical spine : Diagnostic and therapeutic strategies].

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Abstract

[Indexed for MEDLINE] 18. Eur Spine J. 2016 Jul;25(7):2173-84. doi: 10.1007/s00586-015-3831-3. Epub 2015 Feb 26. AOSpine subaxial cervical spine injury classification system. Vaccaro AR(1), Koerner JD(2), Radcliff KE(2), Oner FC(3), Reinhold M(4), Schnake KJ(5), Kandziora F(6), Fehlings MG(7), Dvorak MF(8), Aarabi B(9), Rajasekaran S(10), Schroeder GD(2), Kepler CK(2), Vialle LR(11). Author information: (1)Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. alexvaccaro3@aol.com. (2)Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. (3)University Medical Center, Utrecht, The Netherlands. (4)Department of Orthopaedic and Trauma Surgery, Klinikum Suedstadt Rostock, Suedring 81, 18059, Rostock, Germany. (5)Schön Klinik Nürnberg Fürth, Center for Spinal Surgery, Fürth, Germany. (6)Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Frankfurt, Germany. (7)University of Toronto Spine Program and Toronto Western Hospital, Toronto, ON, Canada. (8)University of British Columbia, Vancouver, BC, Canada. (9)University of Maryland Medical Center, College Park, MD, USA. (10)Ganga Hospital, Coimbatore, Tamil Nadu, India. (11)Catholic University of Parana, Curitiba, Brazil. 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. DOI: 10.1007/s00586-015-3831-3