Teachability and Reliability of a New Classification System for Lower Cervical Spinal Injuries

Zehnder, Scott W.; Lenarz, Christopher J.; Place, Howard M.

doi:10.1097/brs.0b013e3181af053c

Cited by 15 publications

(9 citation statements)

References 15 publications

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“…Using only the spinal injury’s location and true morphological descriptions, excellent agreement ( κ -value: 0.883) and reproducibility ( κ -value: 0.977) can be obtained. Zehnder et al [111] confirmed these findings in an external validation study. One should keep in mind, however, that an excellent reproducibility of a classification system does not say anything about its content and construct validity, nor about its clinical utility.…”

Section: Two Crucial Spinal Injury Characteristics: Location and Morpmentioning

confidence: 57%

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

et al. 2010

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Since Böhler published the first categorization of spinal injuries based on plain radiographic examinations in 1929, numerous classifications have been proposed. Despite all these efforts, however, only a few have been tested for reliability and validity. This methodological, conceptual review summarizes that a spinal injury classification system should be clinically relevant, reliable and accurate. The clinical relevance of a classification is directly related to its content validity. The ideal content of a spinal injury classification should only include injury characteristics of the vertebral column, is primarily based on the increasingly routinely performed CT imaging, and is clearly distinctive from severity scales and treatment algorithms. Clearly defined observation and conversion criteria are crucial determinants of classification systems’ reliability and accuracy. Ideally, two principle spinal injury characteristics should be easy to discern on diagnostic images: the specific location and morphology of the injured spinal structure. Given the current evidence and diagnostic imaging technology, descriptions of the mechanisms of injury and ligamentous injury should not be included in a spinal injury classification. The presence of concomitant neurologic deficits can be integrated in a spinal injury severity scale, which in turn can be considered in a spinal injury treatment algorithm. Ideally, a validation pathway of a spinal injury classification system should be completed prior to its clinical and scientific implementation. This review provides a methodological concept which might be considered prior to the synthesis of new or modified spinal injury classifications.

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Section: Two Crucial Spinal Injury Characteristics: Location and Morpmentioning

confidence: 57%

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

et al. 2010

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“…Another limitation is represented by the difficulties of comparing our data with ICC indicators in other studies. Among present studies that assessed the ICC, 3,4,8 -10 the model and/or form of the ICC are provided in only 2 articles. In one study, authors reported the application of a 2-way random model of the ICC 9 ; however, no data concerning form or the agreement type were provided.…”

Section: Discussionmentioning

confidence: 99%

“…Only 5 published articles have estimated the reliability of the SLIC and CSISS scales, 3,4,8 -10 and only 3 of those were external studies. 8 -10 The CSISS scale has been examined by surgeons with different levels of experience; however, all studies had a single-centre design (Table 1). The SLIC scale has been examined by only experienced surgeons.…”

Section: Introductionmentioning

confidence: 99%

External Multicenter Study of Reliability and Reproducibility for Lower Cervical Spine Injuries Classification Systems—Part 2: An Analysis of the Subaxial Cervical Spine Injury Classification and Cervical Spine Injury Severity Score Scale

Grin

Krylov

Lvov

et al. 2019

Global Spine Journal

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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.

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“…Предложенный авторами нестандартный подход к определению степени повреждений, несмотря на допускаемый субъективизм, не приводит к ожидаемо широкому разбросу результатов при проведении контрольных измерений. Так, показатель согласованности при использовании CSISS составляет, по данным разных исследователей, от 0,883 до 0,983, что является очень высоким значением [32,33]. Для сравнения AOSpine subaxial cervical spine injury classification system, снабженная подробными инструкциями и имеющая жесткие критерии оценки, демонстрирует уровень согласованности не более 0,75 [24,34].…”

Section: количественная оценка степени тяжестиunclassified

The classifications of subaxial cervical spine traumatic injuries. Part 3. The Cervical Spine Injury Severity Score (CSISS)

Слынько¹,

Nekhlopochyn²,

Verbov³

2020

Ukr Neurosurg J

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Teachability and Reliability of a New Classification System for Lower Cervical Spinal Injuries

Abstract: The CSISS is a useful new adjunct in the treatment and classification of lower cervical spine injuries. The system is reliable, reproducible, and teachable. It is clinically useful for all levels of orthopedic training and experience.

Cited by 15 publications

References 15 publications

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

External Multicenter Study of Reliability and Reproducibility for Lower Cervical Spine Injuries Classification Systems—Part 2: An Analysis of the Subaxial Cervical Spine Injury Classification and Cervical Spine Injury Severity Score Scale

The classifications of subaxial cervical spine traumatic injuries. Part 3. The Cervical Spine Injury Severity Score (CSISS)

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