Establishing the Injury Severity of Subaxial Cervical Spine Trauma

Abstract

Study Design. Global cross-sectional survey. Objective. The aim of this study was to validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience. Summary of Background Data. Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: injury morphology, facet injury involvement, neurologic status, and case-specific modifiers. Methods. A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience. Results. A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, P = 0.04), N3 (incomplete spinal cord injury, P = 0.03), and M2 (critical disk herniation, P = 0.04). When stratified by surgeon experience, pairwise comparison showed only two morphological subtypes, B1 (bony posterior tension band injury, P = 0.02) and F2 (unstable facet fracture, P = 0.03), and one neurologic subtype (N3, P = 0.02) exhibited a significant difference in injury severity score. Conclusion. The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience, and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries. Level of Evidence: 4

Home-Based Robotic Upper Limbs Cardiac Telerehabilitation System

“…Patients with orthopedic, neurological, and pulmonary disorders as well as the neurosurgical patients have benefited from a variety of telerehabilitation programs, which have been proven to be beneficial [ 33 ]. Telerehabilitation is thought to provide patients possible advantages such as improved accessibility, less time commitment, and cost efficiency [ 34 , 35 ].…”

The Subaxial Cervical AO Spine Injury Score

“…16 As such, the AO Spine Cervical Classification Validation Group, comprised of several spine surgeons with expertise in spinal trauma, analyzed the injury severity data to generate the Subaxial AOSIS system. 19 While there will always be skepticism when treatment guidelines are not supported by level-1 evidence, many clinical situations simply have a paucity of literature surrounding their treatment guidelines. Furthermore, randomized controlled trials would be unethical in fractures that are clearly unstable and would place the patient at risk of neurologic injury.…”

“…The complete results of the survey study have been previously described. 19 Analysis of the results of the survey were used to rank each subgroup of the classification system into a hierarchical arrangement based on point values assigned to represent relative injury severity. 18 Scores were assigned to each subgroup based on their relative injury severity rating.…”

“…18 While this makes generating an accepted treatment algorithm difficult, it also highlights its necessity, as having a classification system with management recommendations based on global consensus can help patients with these rare injuries. 19 The purpose of this study is to establish a Subaxial Cervical AO Spine Injury Score (Subaxial AOSIS) to accompany the AO Spine SCICS. This process will be accomplished by rendering survey data from spine surgeons around the globe regarding the relative injury severity associated with each of the AO Spine SCICS subgroups into a score that communicates the need for surgical stabilization.…”

“…This process will be accomplished by rendering survey data from spine surgeons around the globe regarding the relative injury severity associated with each of the AO Spine SCICS subgroups into a score that communicates the need for surgical stabilization. 19 The thresholds used to delineate which injury subgroups should be addressed with surgical stabilization will be established at a later date, and will likely take numerous variables into account secondary to lack of existing evidence-based literature.…”