This article provides a detailed illustrated description of currently available classification and scoring systems for lower cervical spine injuries (including Allen–Fergusson, J. Harris et al., C. Argenson et al., and AOSpine classifications, Subaxial Injury Classification System and Cervical Spine Injury Severity Score). The present review primarily aims to discuss the advantages and disadvantages of each classification system.

Study Design: A multicenter observational survey. Objective: To quantify and compare inter- and intraobserver reliability of the subaxial cervical spine injury classification (SLIC) and the cervical spine injury severity score (CSISS) in a multicentric survey of neurosurgeons with different experience levels. Methods: Data concerning 64 consecutive patients who had undergone cervical spine surgery between 2013 and 2017 was evaluated, and we surveyed 37 neurosurgeons from 7 different clinics. All raters were divided into 3 groups depending on their level of experience. Two assessment procedures were performed. Results: For the SLIC, we observed excellent agreement regarding management among experienced surgeons, whereas agreement among less experienced neurosurgeons was moderate and almost twice as unlikely. The sensitivity of SLIC relating to treatment tactics reached as high as 92.2%. For the CSISS, agreement regarding management ranged from medium to substantial, depending on a neurosurgeon’s experience. For less experienced neurosurgeons, the level of agreement concerning surgical management was the same as for the SLIC in not exceeding a moderate level. However, this scale had insufficient sensitivity (slightly exceeding 50%). The reproducibility of both scales was excellent among all raters regardless of their experience level. Conclusions: Our study demonstrated better management reliability, sensitivity, and reproducibility for the SLIC, which provided moderate interrater agreement with moderate to excellent intraclass correlation coefficient indicators for all raters. The CSISS demonstrated high reproducibility; however, large variability in answers prevented raters from reaching a moderate level of agreement. Magnetic resonance imaging integration may increase sensitivity of CSISS in relation to fracture management.

Study Design: Multicenter observational survey study. Objectives: To quantify and compare the inter- and intraobserver reliability of Allen-Fergusson (A-F), Harris, Argenson, and AOSpine (AOS) classifications for cervical spine injuries, in a multicentric survey of neurosurgeons with different levels of experience. Methods: We used data of 64 consecutive patients. Totally, 37 surgeons (from 7 centers), were included in the study. The initial assessment was returned by 36 raters. The second assessment performed after 1.5 months included 24 raters. Results: We received 15 111 answers for 3840 evaluations. Raters reached a fair general agreement of the A-F scale, while the experienced group achieved κ = 0.39. While all groups showed moderate interrater reliability for primary assessment of Harris scale (κ = 0.44), the κ value for experts decreased from 0.58 to 0.49. The Argenson scale demonstrated moderate and substantial agreement among all raters (κ = 0.47 and κ = 0.55, respectively). The AOS scheme primary assessment general kappa value for all types of injuries and across all raters was 0.49, reaching substantial agreement among experts (κ = 0.62) with moderate agreement across beginner and intermediate groups (κ = 0.48 and κ = 0.44, respectively). The second assessment general agreement kappa value reached 0.56. Conclusions: We found the highest values of interobserver agreement and reproducibility among surgeons with different levels of experience with Argenson and AOSpine classifications. The AOSpine scale additionally incorporated more detailed description of compression injuries and facet-joint fractures. Agreement levels reached for Allen-Fergusson and Harris scales were fair and moderate, respectively, indicating difficulty of their application in clinical practice, especially by junior specialists.

Objective. To specify risk factors for the development of surgical site infection in patients operated on for injuries and degenerative diseases of the thoracic and lumbosacral spine through the posterior median approach. Material and Methods. The study included formalized case histories of 415 patients (207 men, 208 women) who were operated on for degenerative diseases (n = 385) or unstable injuries (n = 30) of the spine. The average age of patients was 47 ± 18 years. Out of them, 230 patients had concomitant chronic diseases requiring constant drug treatment. Before statistical processing, the data obtained in the study were classified according to a generally accepted method to determine the possibility of using different statistical methods when comparing groups. The patients were divided into two groups: Group I included patients with pyoinflammatory complications, and Group IIwithout pyoinflammatory complications. Цель исследования. Уточнение факторов риска развития инфекции области хирургического вмешательства у пациентов, оперированных задним срединным доступом по поводу травм и дегенеративно-дистрофических заболеваний грудного и пояснично-крестцового отделов позвоночника. Материал и методы. Материалом исследования послужили формализованные истории болезней 415 пациентов (207 мужчин, 208 женщин), оперированных по поводу дегенеративных заболеваний (n = 385) или нестабильных повреждений (n = 30) позвоночника. Средний возраст больных-47 ± 18 лет. У 230 пациентов имелись сопутствующие хронические заболевания, требующие постоянного медикаментозного лечения. Перед статистической обработкой данные, полученные в результате исследования, классифицировали по общепринятой методике для определения возможности использования различных статистических методов при сравнении групп. Пациенты были разделены на две группы: I-с гнойно-воспалительными осложнениями, II-без гнойно-воспалительных осложнений. Результаты. Выявлено, что следующие факторы достоверно влияют на развитие нагноения послеоперационной раны: металлофиксации, наружное дренирование раны более четырех суток, монокоагуляция с уровня подкожной жировой клетчатки, установка ранорасширителя на период более 1 ч, кровопотеря более 300 мл, оставление рассасывающихся гемостатических материалов в ране, ушивание мышц в зоне ламинэктомии, наложение внутрикожных (косметических) швов. Возраст пациента, предоперационный койкодень, метод изоляции кожи (или его отсутствие), длительность хирургического вмешательства и стаж хирурга не влияют на риск развития инфекции в области хирургического вмешательства. Заключение. Несмотря на то что большинство выявленных факторов риска нагноения послеоперационной раны сводятся к описанию более сложного и продолжительного вмешательства, которое переносится пациентом тяжелее, некоторые выявленные факторы риска потенциально устранимы.