Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
Department of Orthopaedic Surgery, University Medical Center, Utrecht, The Netherlands.
Global Spine J. 2015 Oct;5(5):378-82. doi: 10.1055/s-0035-1549034. Epub 2015 Mar 27.
Study Design Survey of spine surgeons. Objective To determine the reliability with which international spine surgeons identify a posterior ligamentous complex (PLC) injury in a patient with a compression-type vertebral body fracture (type A). Methods A survey was sent to all AOSpine members from the six AO regions of the world. The survey consisted of 10 cases of type A fractures (2 subtype A1, 2 subtype A2, 3 subtype A3, and 3 subtype A4 fractures) with appropriate imaging (plain radiographs, computed tomography, and/or magnetic resonance imaging), and the respondent was asked to identify fractures with a PLC disruption, as well as to indicate if the integrity of the PLC would affect their treatment recommendation. Results Five hundred twenty-nine spine surgeons from all six AO regions of the world completed the survey. The overall interobserver reliability in determining the integrity of the PLC was slight (kappa = 0.11). No substantial regional or experiential difference was identified in determining PLC integrity or its absence; however, a regional difference was identified (p < 0.001) in how PLC integrity influenced the treatment of type A fractures. Conclusion The results of this survey indicate that there is only slight international reliability in determining the integrity of the PLC in type A fractures. Although the biomechanical importance of the PLC is not in doubt, the inability to reliably determine the integrity of the PLC may limit the utility of the M1 modifier in the AOSpine Thoracolumbar Spine Injury Classification System.
研究设计 脊柱外科医生调查。目的 确定国际脊柱外科医生识别具有压缩型椎体骨折（A型）的患者的后韧带复合体（PLC）损伤的可靠性。方法 向来自世界六个 AO 区域的所有 AOSpine 成员发送了一项调查。该调查包括 10 例 A 型骨折（2 例 A1 亚型，2 例 A2 亚型，3 例 A3 亚型和 3 例 A4 亚型骨折），并附有适当的影像学检查（平片、计算机断层扫描和/或磁共振成像），并要求受访者识别 PLC 中断的骨折，并指出 PLC 的完整性是否会影响他们的治疗建议。结果 来自世界六个 AO 区域的 529 名脊柱外科医生完成了调查。确定 PLC 完整性的总体观察者间可靠性为轻度（kappa=0.11）。在确定 PLC 完整性或不存在方面，没有发现实质性的区域或经验差异；然而，在 PLC 完整性如何影响 A 型骨折的治疗方面，确实存在区域差异（p<0.001）。结论 这项调查的结果表明，在确定 A 型骨折中 PLC 完整性方面，国际间的可靠性仅为轻度。尽管 PLC 的生物力学重要性毋庸置疑，但无法可靠地确定 PLC 的完整性可能会限制 AOSpine 胸腰椎脊柱损伤分类系统中 M1 修饰符的实用性。
