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The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex.

Abstract：

STUDY DESIGN:The classification system was derived through a literature review and expert opinion of experienced spine surgeons. In addition, a multicenter reliability and validity study of the system was conducted on a collection of trauma cases. OBJECTIVES:To define a novel classification system for subaxial cervical spine trauma that conveys information about injury pattern, severity, treatment considerations, and prognosis. To evaluate reliability and validity of this system. SUMMARY OF BACKGROUND DATA:Classification of subaxial cervical spine injuries remains largely descriptive, lacking standardization and prognostic information. METHODS:Clinical and radiographic variables encountered in subaxial cervical trauma were identified by a working section of the Spine Trauma Study Group. Significant limitations of existing systems were defined and addressed within the new system. This system, as well as the Harris and Ferguson & Allen systems, was applied by 20 spine surgeons to 11 cervical trauma cases. Six weeks later, the cases were randomly reordered and again scored. Interrater reliability, intrarater reliability, and validity were assessed. RESULTS:Each of 3 main categories (injury morphology, disco-ligamentous complex, and neurologic status) identified as integrally important to injury classification was assigned a weighted score; the injury severity score was obtained by summing the scores from each category. Treatment options were assigned based on threshold values of the severity score. Interrater agreement as assessed by intraclass correlation coefficient of the DLC, morphology, and neurologic status scores was 0.49, 0.57, and 0.87, respectively. Intrarater agreement as assessed by intraclass correlation coefficient of the DLC, morphology, and neurologic status scores was 0.66, 0.75, and 0.90, respectively. Raters agreed with treatment recommendations of the algorithm in 93.3% of cases, suggesting high construct validity. The reliability compared favorably to the Harris and Ferguson & Allen systems. CONCLUSION:The Sub-axial Injury Classification and Severity Scale provides a comprehensive classification system for subaxial cervical trauma. Early validity and reliability data are encouraging.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Vaccaro AR,Hulbert RJ,Patel AA,Fisher C,Dvorak M,Lehman RA Jr,Anderson P,Harrop J,Oner FC,Arnold P,Fehlings M,Hedlund R,Madrazo I,Rechtine G,Aarabi B,Shainline M,Spine Trauma Study Group.

doi

10.1097/BRS.0b013e3181557b92

subject

Has Abstract

pub_date

2007-10-01 00:00:00

pages

2365-74

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-200710010-00015

journal_volume

pub_type

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The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex.