Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany.
Spine (Phila Pa 1976). 2021 May 15;46(10):649-657. doi: 10.1097/BRS.0000000000003873.
Global cross-sectional survey.
The aim of this study was to validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience.
Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: injury morphology, facet injury involvement, neurologic status, and case-specific modifiers.
A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience.
A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, P = 0.04), N3 (incomplete spinal cord injury, P = 0.03), and M2 (critical disk herniation, P = 0.04). When stratified by surgeon experience, pairwise comparison showed only two morphological subtypes, B1 (bony posterior tension band injury, P = 0.02) and F2 (unstable facet fracture, P = 0.03), and one neurologic subtype (N3, P = 0.02) exhibited a significant difference in injury severity score.
The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience, and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.
全球横断面调查。
本研究旨在通过检查外科医生在 AO 地理区域和实践经验方面对损伤严重程度的感知，验证 AO 脊柱下颈椎损伤分类的准确性。
以前的下颈椎损伤分类存在观察者间可靠性和临床适用性差的局限性。为了创建一个具有预测价值的普遍验证方案，AO 脊柱建立了一个下颈椎损伤分类，涉及四个要素：损伤形态、关节突损伤累及、神经状态和病例特异性修饰。
向所有地理区域和各种实践经验的 272 名 AO 脊柱成员发送了一份调查。受访者根据分类系统的每个变量对严重程度进行评分，分值范围从 0（低严重程度）到 100（高严重程度）。主要结果是评估每个损伤类型在地理区域和实践经验水平上的感知损伤严重程度差异。
共收到 189 份回复。总体而言，分类系统在亚型损伤严重程度评分中表现出层次递进。只有三种亚型在地理区域之间的损伤严重程度评分上存在显著差异：F3（游离侧块骨折，P=0.04）、N3（不完全脊髓损伤，P=0.03）和 M2（临界椎间盘突出，P=0.04）。按外科医生经验分层，两两比较仅发现两种形态学亚型，B1（骨后张力带损伤，P=0.02）和 F2（不稳定关节突骨折，P=0.03），以及一种神经学亚型（N3，P=0.02）的损伤严重程度评分存在显著差异。
AO 脊柱下颈椎损伤分类系统已被证明是可靠的，适合患者的适当管理。该研究表明，该分类在地理区域和外科医生经验方面具有很强的可推广性，并为医生之间提供了一种一致的沟通方法，同时涵盖了大多数下颈椎创伤性损伤。
4 级。
