AOSpine subaxial cervical spine injury classification system

• Published in: European spine journal Vol. 25; no. 7; pp. 2173 - 2184
• Main Authors: Vaccaro, Alexander R., Koerner, John D., Radcliff, Kris E., Oner, F. Cumhur, Reinhold, Maximilian, Schnake, Klaus J., Kandziora, Frank, Fehlings, Michael G., Dvorak, Marcel F., Aarabi, Bizhan, Rajasekaran, Shanmuganathan, Schroeder, Gregory D., Kepler, Christopher K., Vialle, Luiz R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2016; Springer Nature B.V
• Subjects: Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - injuries; Consensus; Humans; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Neck Injuries - classification; Neck Injuries - diagnostic imaging; Neurosurgery; Original Article; Reproducibility of Results; Spinal Cord Injuries - classification; Spinal Cord Injuries - diagnostic imaging; Spinal Fractures - classification; Spinal Fractures - diagnostic imaging; Spinal Injuries - classification; Spinal Injuries - diagnostic imaging; Surgical Orthopedics; Spine; Injury; Cervical; Classification; Subaxial; Trauma; AOSpine
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-015-3831-3

Purpose
This project describes a morphology-based subaxial cervical spine traumatic injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes.
Methods
A subaxial cervical spine injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients (
κ
) were calculated for intraobserver and interobserver reliability.
Results
The classification system is based on three injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all injury subtypes (
κ
 = 0.75 and 0.64, respectively).
Conclusions
The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.