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Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System

2022; Volume: 38; Issue: 1 Linguagem: Inglês

10.3171/2022.6.spine22454

1547-5654

Mark J. Lambrechts, Gregory D. Schroeder, Brian A. Karamian, José A. Canseco, F. Cumhur Öner, Lorin M. Benneker, Richard J. Bransford, Frank Kandziora, Shanmuganathan Rajasekaran, Mohammad El‐Sharkawi, Rishi Mugesh Kanna, Andrei Fernandes Joaquim, Klaus J. Schnake, Christopher K. Kepler, Alexander R. Vaccaro, _ _, _ _, Dewan Asif, Sachin Borkar, Joseph Bakar, Slavisa Zagorac, Welege Wimalachandra, Oleksandr Garashchuk, Francisco Verdu-Lopez, Giorgio Lofrese, Shyamasunder N Bhat, Oke Obadaseraye, A. Partenheimer, Marion Riehle, Eugen Cesar Popescu, Christian Konrads, Nur Aida Faruk Senan, Adetunji Toluse, Nuno Nevès, Takahiro Sunami, Bart Kuipers, Jayakumar Subbiah, Anas Dyab, Peter Loughenbury, Derek T. Cawley, René Schmidt, Vijay Kumar Loya, Farhan Karim, Zacharia Silk, Michele Parolin, Hisco Robijn, Al Kalbani, Ricky Rasschaert, Christian M. Müller, Marc J. Nieuwenhuijse, Selim Ayhan, Shay Menachem, Sarvdeep Singh Dhatt, Nasser Khan, Subramaniam Haribabu, Moses Kimani, Olger Alarcon, Nnaemeka Alor, Dinesh N. Iyer, Michal Ziga, Konstantinos Gousias, Gisela Murray, Michel Triffaux, Sebastian Hartmann, Sung-Joo Yuh, Siegmund Lang, Kyaw Linn, Charanjit Singh Dhillon, Waeel Hamouda, S. Carnesecchi, Vishal Kumar, Lady Lozano Cari, Shah Gyanendra, Takeo Furuya, Federico Sartor, Fernando Martín González, Hitesh Dabasia, Wongthawat Liawrungrueang, Lincoln Liu, Younes El Moudni, Ratko Yurak, Héctor Aceituno, Madhivanan Karthigeyan, Andreas K. Demetriades, Sathish Muthu, Matti Scholz, Wael Alsammak, Komal Chandrachari, Khoh Phaik Shan, Sokol Trungu, Joost Dejaegher, O F González Marroquín, Moisa Horatiu Alexandru, Máximo-Alberto Díez-Ulloa, Paulo Pereira, Claudio Bernucci, Christian Hohaus, Miltiadis Georgiopoulos, Annika Heuer, Ahmed Arieff Atan, Mark Murerwa, Richard A. Lindtner, Manjul Tripathi, Huynh Hieu Kim, Ahmed Hassan, Norah Foster, Amanda O’Halloran, Koroush Kabir, Mario Ganau, Daniel J. Santa Cruz, Amin Henine, Jerônimo Buzetti Milano, Mbarak Abeid, Arnaldo Sousa, Satyashiva Munjal, Mahmoud Alkharsawi, Muhammad Mirza, Parmenion Tsitsopoulos, Fon-Yih Tsuang, Oliver Risenbeck, Viswanadha Arun-Kumar, Samer Samy, David Orosco, Gerardo Zambito-Brondo, Nauman Chaudhry, L. Márquez, Jacob Lepard, Juan Carlos Muñoz, Stipe Ćorluka, Soh Reuben, Ariel Kaen, Nishanth Ampar, S. Bigdon, Damián Caba, Francisco De Miranda, Loren Lay, Ivan Marintschev, Muhammad Imran, Sandeep Mohindra, Naga Raju Reddycherla, Pedro Luis Bazán, Abduljabbar Alhammoud, Iain Feeley, Konstantinos Margetis, Alexander Durst, Ashok Kumar Jani, Rian Souza Vieira, Felipe Santos, Joshua Karlin, Nicola Montemurro, Sergey Mlyavykh, Brian Sonkwe, Darko Perović, Juan Lourido, Alessandro Ramieri, Eduardo Laos, Uri Hadesberg, Andrei-Stefan Iencean, Pedro Leão Neves, Eduardo Bertolini, Naresh Kumar, Philippe Bancel, Bishnu Sharma, John D. Koerner, Eloy Rusafa Neto, Nima Ostadrahimi, Olga Morillo, Rakesh Kumar, Andreas Morakis, Amauri Godinho, P. Keerthivasan, Richard Menger, Louis Carius, Rajesh Bahadur Lakhey, Ehab Shiban, Vishal Borse, C. Elizabeth Boudreau, Gabriel Lacerda, Paterakis Konstantinos, Mubder Mohammed Saeed, Toivo Hasheela, Susana Núñez-Pereira, Jay S. Reidler, Nimrod Rahamimov, Mikołaj Zimny, Devi Prakash Tokala, Hossein Elgafy, Ketan Badani, Ng Bing Wui, Cesar Sosa Juarez, Thomas Repantis, I. Fernández-Bances, John P. Kleimeyer, Nicolas Lauper, L.M. Romero-Muñoz, AS Yusuf, Zdenek Klez, John Afolayan, Joost Rutges, Alon Grundshtein, Rafał Załuski, Stavros I. Stavridis, Takeshi Aoyama, Petr Vachata, Wiktor Urbański, Martin Tejeda, Luis Muñiz, Susan Karanja, Antonio Martín-Benlloch, Heiller Torres, Chee-Huan Pan, Luis Duchén, Yuki Fujioka, Meriç Enercan, Mauro Pluderi, Catalin Majer, Vijay Kamath,

Spine and Intervertebral Disc Pathology

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.