Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System

AO Spine Upper Cervical Injury Classification International Members

doi:10.3171/2022.6.SPINE22454

Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System

AO Spine Upper Cervical Injury Classification International Members

Bar-Ilan University - Azrieli Faculty of Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and “other” surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

Original language	English
Pages (from-to)	31-41
Number of pages	11
Journal	Journal of Neurosurgery: Spine
Volume	38
Issue number	1
DOIs	https://doi.org/10.3171/2022.6.SPINE22454
State	Published - 1 Jan 2023

Bibliographical note

Publisher Copyright:
© 2023 The authors, CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Funding

This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Trauma, a focused group of international trauma experts. AO Spine is a clinical division of the AO Foundation, which is an independent, medically guided, not-for-profit organization. Study support was provided directly through the AO Spine Research Department. The study was funded and supported by AO Spine; statistical support was provided. Dr. Benneker: consultant for Icotec and Kuros; and clinical or research support for the study described (includes equipment or material) from Sentryx. Dr. Bransford: speakers bureau for DePuy Synthes and Globus. Dr. Schnake: consultant for AO Spine International. Dr. Vaccaro: ownership in Advanced Spinal Intellectual Properties, Atlas Spine, Avaz Surgical, AVKN Patient Driven Care, Bonovo Orthopaedics, Computational Biodynamics, Cytonics, Deep Health, Dimension Orthotics LLC, Electrocore, Flagship Surgical, FlowPharma, Globus, Innovative Surgical Design, Jushi, NuVasive, Orthobullets, Parvizi Surgical Innovation, Progressive Spinal Technologies, Replication Medica, Spine Medica, Spineology, Stout Medical, Surgalign, and ViewFi Health; royalties from Aesculap, Atlas Spine, Globus, Medtronic, Spine Wave, and Stryker Spine; and board member of National Spine Health Foundation and Sentryx. We would like to thank Olesja Hazenbiller for her assistance in developing the methodology and providing support during the study. We would also like to thank Hans Bauer, senior biostatistician at Staburo GmbH, for his assistance with the statistical analysis. This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Trauma, a focused group of international trauma experts. AO Spine is a clinical division of the AO Foundation, which is an independent, medically guided, not-for-profit organization. Study support was provided directly through the AO Spine Research Department.

Funders	Funder number
AO Spine Research Department
AORN Foundation
AOSpine

Keywords

AO Spine
neurosurgeon
orthopedic spine surgeon
reliability
reproducibility
trauma
upper cervical spine

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10.3171/2022.6.SPINE22454

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@article{ee7ca2e7e35d407c8160117083960925,

title = "Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System",

abstract = "OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and “other” surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.",

keywords = "AO Spine, neurosurgeon, orthopedic spine surgeon, reliability, reproducibility, trauma, upper cervical spine",

author = "{AO Spine Upper Cervical Injury Classification International Members} and Lambrechts, {Mark J.} and Schroeder, {Gregory D.} and Karamian, {Brian A.} and Canseco, {Jose A.} and Oner, {F. Cumhur} and Benneker, {Lorin M.} and Bransford, {Richard J.} and Frank Kandziora and Shanmuganathan Rajasekaran and Mohammad El-Sharkawi and Rishi Kanna and Joaquim, {Andrei Fernandes} and Klaus Schnake and Kepler, {Christopher K.} and Vaccaro, {Alexander R.} and Dewan Asif and Sachin Borkar and Joseph Bakar and Slavisa Zagorac and Welege Wimalachandra and Oleksandr Garashchuk and Francisco Verdu-Lopez and Giorgio Lofrese and Pragnesh Bhatt and Oke Obadaseraye and Axel Partenheimer and Marion Riehle and Popescu, {Eugen Cesar} and Christian Konrads and Senan, {Nur Aida Faruk} and Adetunji Toluse and Nuno Neves and Takahiro Sunami and Bart Kuipers and Jayakumar Subbiah and Anas Dyab and Peter Loughenbury and Derek Cawley and Ren{\'e} Schmidt and Loya Kumar and Farhan Karim and Zacharia Silk and Michele Parolin and Hisco Robijn and Al Kalbani and Ricky Rasschaert and Christian M{\"u}ller and Marc Nieuwenhuijse and Selim Ayhan and Nimrod Rahamimov",

note = "Publisher Copyright: {\textcopyright} 2023 The authors, CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)",

year = "2023",

month = jan,

day = "1",

doi = "10.3171/2022.6.SPINE22454",

language = "אנגלית",

volume = "38",

pages = "31--41",

journal = "Journal of Neurosurgery: Spine",

issn = "1547-5654",

publisher = "American Association of Neurological Surgeons",

number = "1",

}

TY - JOUR

T1 - Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System

AU - AO Spine Upper Cervical Injury Classification International Members

AU - Lambrechts, Mark J.

AU - Schroeder, Gregory D.

AU - Karamian, Brian A.

AU - Canseco, Jose A.

AU - Oner, F. Cumhur

AU - Benneker, Lorin M.

AU - Bransford, Richard J.

AU - Kandziora, Frank

AU - Rajasekaran, Shanmuganathan

AU - El-Sharkawi, Mohammad

AU - Kanna, Rishi

AU - Joaquim, Andrei Fernandes

AU - Schnake, Klaus

AU - Kepler, Christopher K.

AU - Vaccaro, Alexander R.

AU - Asif, Dewan

AU - Borkar, Sachin

AU - Bakar, Joseph

AU - Zagorac, Slavisa

AU - Wimalachandra, Welege

AU - Garashchuk, Oleksandr

AU - Verdu-Lopez, Francisco

AU - Lofrese, Giorgio

AU - Bhatt, Pragnesh

AU - Obadaseraye, Oke

AU - Partenheimer, Axel

AU - Riehle, Marion

AU - Popescu, Eugen Cesar

AU - Konrads, Christian

AU - Senan, Nur Aida Faruk

AU - Toluse, Adetunji

AU - Neves, Nuno

AU - Sunami, Takahiro

AU - Kuipers, Bart

AU - Subbiah, Jayakumar

AU - Dyab, Anas

AU - Loughenbury, Peter

AU - Cawley, Derek

AU - Schmidt, René

AU - Kumar, Loya

AU - Karim, Farhan

AU - Silk, Zacharia

AU - Parolin, Michele

AU - Robijn, Hisco

AU - Kalbani, Al

AU - Rasschaert, Ricky

AU - Müller, Christian

AU - Nieuwenhuijse, Marc

AU - Ayhan, Selim

AU - Rahamimov, Nimrod

PY - 2023/1/1

Y1 - 2023/1/1

N2 - OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and “other” surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

AB - OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and “other” surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

KW - AO Spine

KW - neurosurgeon

KW - orthopedic spine surgeon

KW - reliability

KW - reproducibility

KW - trauma

KW - upper cervical spine

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SN - 1547-5654

VL - 38

SP - 31

EP - 41

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

IS - 1

ER -

Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System

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