Reinhold Maximilian, Audigé Laurent, Schnake Klaus John, Bellabarba Carlo, Dai Li-Yang, Oner F Cumhur
Department of Orthopaedic Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Eur Spine J. 2013 Oct;22(10):2184-201. doi: 10.1007/s00586-013-2738-0. Epub 2013 Mar 19.
The AO Spine Classification Group was established to propose a revised AO spine injury classification system. This paper provides details on the rationale, methodology, and results of the initial stage of the revision process for injuries of the thoracic and lumbar (TL) spine.
In a structured, iterative process involving five experienced spine trauma surgeons from various parts of the world, consecutive cases with TL injuries were classified independently by members of the classification group, and analyzed for classification reliability using the Kappa coefficient (κ) and for accuracy using latent class analysis. The reasons for disagreements were examined systematically during review meetings. In four successive sessions, the system was revised until consensus and sufficient reproducibility were achieved.
The TL spine injury system is based on three main injury categories adapted from the original Magerl AO concept: A (compression), B (tension band), and C (displacement) type injuries. Type-A injuries include four subtypes (wedge-impaction/split-pincer/incomplete burst/complete burst); B-type injuries are divided between purely osseous and osseo-ligamentous disruptions; and C-type injuries are further categorized into three subtypes (hyperextension/translation/separation). There is no subgroup division. The reliability of injury types (A, B, C) was good (κ = 0.77). The surgeons' pairwise Kappa ranged from 0.69 to 0.90. Kappa coefficients κ for reliability of injury subtypes ranged from 0.26 to 0.78.
The proposed TL spine injury system is based on clinically relevant parameters. Final evaluation data showed reasonable reliability and accuracy. Further validation of the proposed revised AO Classification requires follow-up evaluation sessions and documentation by more surgeons from different countries and backgrounds and is subject to modification based on clinical parameters during subsequent phases.
AO脊柱分类小组的成立旨在提出一种修订后的AO脊柱损伤分类系统。本文详细介绍了胸腰椎（TL）损伤修订过程初始阶段的基本原理、方法和结果。
在一个结构化的迭代过程中，来自世界各地的五名经验丰富的脊柱创伤外科医生参与其中，分类小组的成员对连续的TL损伤病例进行独立分类，并使用卡帕系数（κ）分析分类可靠性，使用潜在类别分析评估准确性。在审查会议期间系统地检查分歧原因。在连续的四个阶段中，对该系统进行修订，直至达成共识并实现足够的可重复性。
TL脊柱损伤系统基于从原始Magerl AO概念改编而来的三个主要损伤类别：A（压缩）、B（张力带）和C（移位）型损伤。A型损伤包括四个亚型（楔形撞击/劈裂钳夹/不完全爆裂/完全爆裂）；B型损伤分为单纯骨性和骨韧带性破坏；C型损伤进一步分为三个亚型（过伸/平移/分离）。没有亚组划分。损伤类型（A、B、C）的可靠性良好（κ = 0.77）。外科医生之间的两两卡帕值范围为0.69至0.90。损伤亚型可靠性的卡帕系数κ范围为0.26至0.78。
所提出的TL脊柱损伤系统基于临床相关参数。最终评估数据显示出合理的可靠性和准确性。对提议的修订AO分类的进一步验证需要更多来自不同国家和背景的外科医生进行后续评估并记录，并且在后续阶段可能会根据临床参数进行修改。
