An international validation of the AO spine subaxial injury classification system

Brian A. Karamian; Gregory D. Schroeder; Mark J. Lambrechts; Jose A. Canseco; Cumhur Oner; Emiliano Vialle; Shanmuganathan Rajasekaran; Marcel R. Dvorak; Lorin M. Benneker; Frank Kandziora; Klaus Schnake; Christopher K. Kepler; Alexander R. Vaccaro; AO Spine Subaxial Classification Group Members; Joost Rutges

doi:10.1007/s00586-022-07467-6

An international validation of the AO spine subaxial injury classification system

Brian A. Karamian, Gregory D. Schroeder, Mark J. Lambrechts^*, Jose A. Canseco, Cumhur Oner, Emiliano Vialle, Shanmuganathan Rajasekaran, Marcel R. Dvorak, Lorin M. Benneker, Frank Kandziora, Klaus Schnake, Christopher K. Kepler, Alexander R. Vaccaro, AO Spine Subaxial Classification Group Members, Joost Rutges

^*Corresponding author for this work

Orthopedics and Sports Medicine

Research output: Contribution to journal › Article › Academic › peer-review

11 Citations (Scopus)

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Abstract

Purpose:

To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions.

Methods:

A live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (ƙ = 0–0.20), fair (ƙ = 0.21–0.40), moderate (ƙ = 0.41–0.60), substantial (ƙ = 0.61–0.80), or excellent (ƙ = > 0.80) as determined by the Landis and Koch classification.

Results:

A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (ƙ = 0.87), while fracture subtype (ƙ = 0.80) and facet injury were substantial (ƙ = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (ƙ = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (ƙ = 0.76).

Conclusion:

The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.

Original language	English
Article number	32
Pages (from-to)	46-54
Number of pages	9
Journal	European Spine Journal
Volume	32
Issue number	1
DOIs	https://doi.org/10.1007/s00586-022-07467-6
Publication status	Published - 30 Nov 2023

Bibliographical note

Publisher Copyright:
© 2022, The Author(s).

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An international validation of the AO spine subaxial injury classification systemFinal published version, 598 KBLicence: CC BY

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Karamian, B. A., Schroeder, G. D., Lambrechts, M. J., Canseco, J. A., Oner, C., Vialle, E., Rajasekaran, S., Dvorak, M. R., Benneker, L. M., Kandziora, F., Schnake, K., Kepler, C. K., Vaccaro, A. R., AO Spine Subaxial Classification Group Members, & Rutges, J. (2023). An international validation of the AO spine subaxial injury classification system. European Spine Journal, 32(1), 46-54. Article 32. https://doi.org/10.1007/s00586-022-07467-6

@article{de7a1e8c885748b4965c2258068e4a94,

title = "An international validation of the AO spine subaxial injury classification system",

abstract = "Purpose: To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions. Methods: A live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (ƙ = 0–0.20), fair (ƙ = 0.21–0.40), moderate (ƙ = 0.41–0.60), substantial (ƙ = 0.61–0.80), or excellent (ƙ = > 0.80) as determined by the Landis and Koch classification. Results: A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (ƙ = 0.87), while fracture subtype (ƙ = 0.80) and facet injury were substantial (ƙ = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (ƙ = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (ƙ = 0.76). Conclusion: The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.",

author = "Karamian, {Brian A.} and Schroeder, {Gregory D.} and Lambrechts, {Mark J.} and Canseco, {Jose A.} and Cumhur Oner and Emiliano Vialle and Shanmuganathan Rajasekaran and Dvorak, {Marcel R.} and Benneker, {Lorin M.} and Frank Kandziora and Klaus Schnake and Kepler, {Christopher K.} and Vaccaro, {Alexander R.} and {AO Spine Subaxial Classification Group Members} and Costa, {Bruno Lourenco} and Martin Estefan and Ahmed Dawoud and Ariel Kaen and Yuh, {Sung Joo} and Segundo Fuego and Francisco Mannara and Gunaseelan Ponnusamy and Tarun Suri and Subiiah Jayakumar and Rodriguez, {Luis Cuchen} and Derek Cawley and Amauri Godinho and Johnny Duerinck and Nicola Montemurro and Kubilay Ozdener and Zachary Hickman and Alsammak Wael and Dilip Gopalakrishnan and Bruno Santos and Olga Morillo and Yasunori Sorimachi and Naohisa Miyakoshi and Mahmoud Alkharsawi and Nimrod Rahamimov and Vijay Loya and Peter Loughenbury and Jose Rodrigues and Nanda Ankur and Olger Alarcon and Nishanth Ampar and Kai Sprengel and Macherla Subramaniam and Kyaw Linn and Panchu Subramanian and Georg Osterhoff and Joost Rutges",

note = "Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2023",

month = nov,

day = "30",

doi = "10.1007/s00586-022-07467-6",

language = "English",

volume = "32",

pages = "46--54",

journal = "European Spine Journal",

issn = "0940-6719",

publisher = "Springer-Verlag",

number = "1",

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Karamian, BA, Schroeder, GD, Lambrechts, MJ, Canseco, JA, Oner, C, Vialle, E, Rajasekaran, S, Dvorak, MR, Benneker, LM, Kandziora, F, Schnake, K, Kepler, CK, Vaccaro, AR, AO Spine Subaxial Classification Group Members & Rutges, J 2023, 'An international validation of the AO spine subaxial injury classification system', European Spine Journal, vol. 32, no. 1, 32, pp. 46-54. https://doi.org/10.1007/s00586-022-07467-6

TY - JOUR

T1 - An international validation of the AO spine subaxial injury classification system

AU - Karamian, Brian A.

AU - Schroeder, Gregory D.

AU - Lambrechts, Mark J.

AU - Canseco, Jose A.

AU - Oner, Cumhur

AU - Vialle, Emiliano

AU - Rajasekaran, Shanmuganathan

AU - Dvorak, Marcel R.

AU - Benneker, Lorin M.

AU - Kandziora, Frank

AU - Schnake, Klaus

AU - Kepler, Christopher K.

AU - Vaccaro, Alexander R.

AU - AO Spine Subaxial Classification Group Members

AU - Costa, Bruno Lourenco

AU - Estefan, Martin

AU - Dawoud, Ahmed

AU - Kaen, Ariel

AU - Yuh, Sung Joo

AU - Fuego, Segundo

AU - Mannara, Francisco

AU - Ponnusamy, Gunaseelan

AU - Suri, Tarun

AU - Jayakumar, Subiiah

AU - Rodriguez, Luis Cuchen

AU - Cawley, Derek

AU - Godinho, Amauri

AU - Duerinck, Johnny

AU - Montemurro, Nicola

AU - Ozdener, Kubilay

AU - Hickman, Zachary

AU - Wael, Alsammak

AU - Gopalakrishnan, Dilip

AU - Santos, Bruno

AU - Morillo, Olga

AU - Sorimachi, Yasunori

AU - Miyakoshi, Naohisa

AU - Alkharsawi, Mahmoud

AU - Rahamimov, Nimrod

AU - Loya, Vijay

AU - Loughenbury, Peter

AU - Rodrigues, Jose

AU - Ankur, Nanda

AU - Alarcon, Olger

AU - Ampar, Nishanth

AU - Sprengel, Kai

AU - Subramaniam, Macherla

AU - Linn, Kyaw

AU - Subramanian, Panchu

AU - Osterhoff, Georg

AU - Rutges, Joost

PY - 2023/11/30

Y1 - 2023/11/30

N2 - Purpose: To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions. Methods: A live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (ƙ = 0–0.20), fair (ƙ = 0.21–0.40), moderate (ƙ = 0.41–0.60), substantial (ƙ = 0.61–0.80), or excellent (ƙ = > 0.80) as determined by the Landis and Koch classification. Results: A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (ƙ = 0.87), while fracture subtype (ƙ = 0.80) and facet injury were substantial (ƙ = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (ƙ = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (ƙ = 0.76). Conclusion: The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.

AB - Purpose: To validate the AO Spine Subaxial Injury Classification System with participants of various experience levels, subspecialties, and geographic regions. Methods: A live webinar was organized in 2020 for validation of the AO Spine Subaxial Injury Classification System. The validation consisted of 41 unique subaxial cervical spine injuries with associated computed tomography scans and key images. Intraobserver reproducibility and interobserver reliability of the AO Spine Subaxial Injury Classification System were calculated for injury morphology, injury subtype, and facet injury. The reliability and reproducibility of the classification system were categorized as slight (ƙ = 0–0.20), fair (ƙ = 0.21–0.40), moderate (ƙ = 0.41–0.60), substantial (ƙ = 0.61–0.80), or excellent (ƙ = > 0.80) as determined by the Landis and Koch classification. Results: A total of 203 AO Spine members participated in the AO Spine Subaxial Injury Classification System validation. The percent of participants accurately classifying each injury was over 90% for fracture morphology and fracture subtype on both assessments. The interobserver reliability for fracture morphology was excellent (ƙ = 0.87), while fracture subtype (ƙ = 0.80) and facet injury were substantial (ƙ = 0.74). The intraobserver reproducibility for fracture morphology and subtype were excellent (ƙ = 0.85, 0.88, respectively), while reproducibility for facet injuries was substantial (ƙ = 0.76). Conclusion: The AO Spine Subaxial Injury Classification System demonstrated excellent interobserver reliability and intraobserver reproducibility for fracture morphology, substantial reliability and reproducibility for facet injuries, and excellent reproducibility with substantial reliability for injury subtype.

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U2 - 10.1007/s00586-022-07467-6

DO - 10.1007/s00586-022-07467-6

M3 - Article

C2 - 36449081

AN - SCOPUS:85143208456

SN - 0940-6719

VL - 32

SP - 46

EP - 54

JO - European Spine Journal

JF - European Spine Journal

IS - 1

M1 - 32

ER -

An international validation of the AO spine subaxial injury classification system

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