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Jerome R. Hoffman - One of the best experts on this subject based on the ideXlab platform.
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a prospective multicenter study of Cervical Spine Injury in children
2001Co-Authors: Peter Viccellio, William R Mower, Harold K Simon, Barry D Pressman, Manish N Shah, Jerome R. HoffmanAbstract:Objective. Pediatric victims of blunt trauma have developmental and anatomic characteristics that can make it difficult to assess their risk of Cervical Spine Injury (CSI). Previous reports, all retrospective in nature, have not identified any cases of CSI in either children or adults in the absence of neck pain, neurologic symptoms, distracting Injury, or altered mental status. The objective of this study was to examine the incidence and spectrum of Spine Injury in patients who are younger than 18 years and to evaluate the efficacy of the National Emergency X-Radiography Utilization Study (NEXUS) decision instrument for obtaining Cervical Spine radiography in pediatric trauma victims. Methods. We performed a prospective, multicenter study to evaluate pediatric blunt trauma victims. All patients who presented to participating emergency departments underwent clinical evaluation before radiographic imaging. The presence or absence of the following criteria was noted: midline Cervical tenderness, altered level of alertness, evidence of intoxication, neurologic abnormality, and presence of painful distracting Injury. Presence or absence of each individual criterion was documented for each patient before radiographic imaging, unless the patient was judged to be too unstable to complete the clinical evaluation before radiographs. The decision to radiograph a patient was entirely at the physician9s discretion and not driven by the NEXUS questionnaire. The presence or absence of CSI was based on the final interpretation of all radiographic studies. Data on all patients who were younger than 18 years were sequestered from the main database for separate analysis. Results. There were 3065 patients (9.0% of all NEXUS patients) who were younger than 18 years in this cohort, 30 of whom (0.98%) sustained a CSI. Included in the study were 88 children who were younger than 2, 817 who were between 2 and 8, and 2160 who were 8 to 17. Fractures of the lower Cervical vertebrae (C5–C7) accounted for 45.9% of pediatric CSIs. No case of spinal cord Injury without radiographic abnormality was reported in any child in this study, although 22 cases were reported in adults. Only 4 of the 30 injured children were younger than 9 years, and none was younger than 2 years. Tenderness and distracting Injury were the 2 most common abnormalities noted in patients with and without CSI. The decision rule correctly identified all pediatric CSI victims (sensitivity: 100.0%; 95% confidence interval: 87.8%–100.0%) and correctly designated 603 patients as low risk for CSI (negative predictive value: 100.0%; 95% confidence interval: 99.4%–100.0%). Conclusions. The lower Cervical Spine is the most common site of CSI in children, and fractures are the most common type of Injury. CSI is rare among patients aged 8 years or younger. The NEXUS decision instrument performed well in children, and its use could reduce pediatric Cervical Spine imaging by nearly 20%. However, the small number of infants and toddlers in the study suggests caution in applying the NEXUS criteria to this particular age group.
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a prospective multicenter study of Cervical Spine Injury in children
2001Co-Authors: Peter Viccellio, William R Mower, Harold K Simon, Barry D Pressman, Manish N Shah, Jerome R. HoffmanAbstract:Objective. Pediatric victims of blunt trauma have developmental and anatomic characteristics that can make it difficult to assess their risk of Cervical Spine Injury (CSI). Previous reports, all retrospective in nature, have not identified any cases of CSI in either children or adults in the absence of neck pain, neurologic symptoms, distracting Injury, or altered mental status. The objective of this study was to examine the incidence and spectrum of Spine Injury in patients who are younger than 18 years and to evaluate the efficacy of the National Emergency X-Radiography Utilization Study (NEXUS) decision instrument for obtaining Cervical Spine radiog- raphy in pediatric trauma victims. Methods. We performed a prospective, multicenter study to evaluate pediatric blunt trauma victims. All patients who presented to participating emergency de- partments underwent clinical evaluation before radio- graphic imaging. The presence or absence of the follow- ing criteria was noted: midline Cervical tenderness, altered level of alertness, evidence of intoxication, neu- rologic abnormality, and presence of painful distracting Injury. Presence or absence of each individual criterion was documented for each patient before radiographic imaging, unless the patient was judged to be too unstable to complete the clinical evaluation before radiographs. The decision to radiograph a patient was entirely at the physician's discretion and not driven by the NEXUS questionnaire. The presence or absence of CSI was based on the final interpretation of all radiographic studies. Data on all patients who were younger than 18 years were sequestered from the main database for separate analysis. Results. There were 3065 patients (9.0% of all NEXUS patients) who were younger than 18 years in this cohort, 30 of whom (0.98%) sustained a CSI. Included in the study were 88 children who were younger than 2, 817 who were between 2 and 8, and 2160 who were 8 to 17. Fractures of the lower Cervical vertebrae (C5-C7) ac- counted for 45.9% of pediatric CSIs. No case of spinal cord Injury without radiographic abnormality was re- ported in any child in this study, although 22 cases were reported in adults. Only 4 of the 30 injured children were younger than 9 years, and none was younger than 2 years. Tenderness and distracting Injury were the 2 most com- mon abnormalities noted in patients with and without CSI. The decision rule correctly identified all pediatric CSI victims (sensitivity: 100.0%; 95% confidence interval: 87.8%-100.0%) and correctly designated 603 patients as low risk for CSI (negative predictive value: 100.0%; 95% confidence interval: 99.4%-100.0%). Conclusions. The lower Cervical Spine is the most common site of CSI in children, and fractures are the most common type of Injury. CSI is rare among patients aged 8 years or younger. The NEXUS decision instru- ment performed well in children, and its use could re- duce pediatric Cervical Spine imaging by nearly 20%. However, the small number of infants and toddlers in the study suggests caution in applying the NEXUS crite- ria to this particular age group. Pediatrics 2001;108(2). URL: http://www.pediatrics.org/cgi/content/full/108/2/ e20; Cervical Spine, radiography, Injury, pediatric.
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distribution and patterns of blunt traumatic Cervical Spine Injury
2001Co-Authors: William Goldberg, Stefan Tigges, Jerome R. Hoffman, Charles F Mueller, Edward A Panacek, William R MowerAbstract:STUDY OBJECTIVE: Previous studies of Cervical Spine Injury involve individual institutions or special populations. There is currently little reliable information regarding natural Cervical Spine Injury patterns after blunt trauma. This substudy of the National Emergency X-Radiography Utilization Study project was designed to accurately assess the prevalence, spectrum, and distribution of Cervical Spine Injury after blunt trauma. METHODS: We prospectively enrolled all patients with blunt trauma undergoing Cervical Spine radiography at 21 diverse institutions. Injury status was determined by review of all radiographic studies obtained on each patient. For each individual Injury, we recorded which specific films revealed the Injury, the level and location of Injury on each vertebra, and the age and sex of the patient. RESULTS: Of 34,069 enrolled patients with blunt trauma, 818 (2.4%) individuals had a total of 1,496 distinct Cervical Spine injuries to 1,285 different Cervical Spine structures. The second Cervical vertebra was the most common level of Injury (286 [24.0%] fractures, including 92 odontoid fractures), and 470 (39.3%) fractures occurred in the 2 lowest Cervical vertebrae (C6 and C7). The vertebral body, injured in 235 patients, was the most frequent site of fracture. Nearly one third of all injuries (29.3%) were considered clinically insignificant. CONCLUSION: Cervical Spine injuries occur in a small minority of patients with blunt trauma who undergo imaging. The atlantoaxial region is the most common site of Injury, and the sixth and seventh vertebrae are involved in over one third of all injuries. Other Spine levels are much more commonly involved than has previously been appreciated. A substantial minority of radiographically defined Cervical Spine injuries are of little clinical importance.
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Epidemiology of Cervical Spine Injury victims
2001Co-Authors: Douglas W. Lowery, Marlena M. Wald, Brian J. Browne, Stefan Tigges, Jerome R. HoffmanAbstract:Abstract Study Objective: We sought to characterize demographics and Injury patterns among patients undergoing emergency department Cervical Spine radiography for blunt traumatic Injury. Methods: All patients with blunt trauma undergoing Cervical Spine radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before Cervical Spine radiography. Results: Demographic factors associated with Cervical Spine Injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09; 95% confidence interval [CI] 1.77 to 2.59); "other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19); male sex (RR 1.72, 95% CI 1.48 to 2.00); and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of Cervical Spine Injury. Conclusion: Among patients undergoing ED Cervical Spine radiography, Cervical Spine Injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because Cervical Spine Injury occurs in patients in all demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.[Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR, for the NEXUS Group. Epidemiology of Cervical Spine Injury victims. Ann Emerg Med. July 2001;38:12-16.]
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selective Cervical Spine radiography in blunt trauma methodology of the national emergency x radiography utilization study nexus
1998Co-Authors: Jerome R. Hoffman, Allan B Wolfson, Knox H ToddAbstract:Fear of failure to identify Cervical Spine Injury has led to extremely liberal use of radiography in patients with blunt trauma and remotely possible neck Injury. A number of previous retrospective and small prospective studies have tried to address the question of whether any clinical criteria can identify patients, from among this group, at sufficiently low risk that Cervical Spine radiography is unnecessary. The National Emergency X-Radiography Utilization Study (NEXUS) is a very large, federally supported, multicenter, prospective study designed to define the sensitivity, for detecting significant Cervical Spine Injury, of criteria previously shown to have high negative predictive value. Done at 23 different emergency departments across the United States and projected to enroll more than 20 times as many patients with Cervical Spine Injury than any previous study, NEXUS should be able to answer definitively questions about the validity and reliability of clinical criteria used as a preliminary screen for Cervical Spine Injury.
William R Mower - One of the best experts on this subject based on the ideXlab platform.
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a prospective multicenter study of Cervical Spine Injury in children
2001Co-Authors: Peter Viccellio, William R Mower, Harold K Simon, Barry D Pressman, Manish N Shah, Jerome R. HoffmanAbstract:Objective. Pediatric victims of blunt trauma have developmental and anatomic characteristics that can make it difficult to assess their risk of Cervical Spine Injury (CSI). Previous reports, all retrospective in nature, have not identified any cases of CSI in either children or adults in the absence of neck pain, neurologic symptoms, distracting Injury, or altered mental status. The objective of this study was to examine the incidence and spectrum of Spine Injury in patients who are younger than 18 years and to evaluate the efficacy of the National Emergency X-Radiography Utilization Study (NEXUS) decision instrument for obtaining Cervical Spine radiography in pediatric trauma victims. Methods. We performed a prospective, multicenter study to evaluate pediatric blunt trauma victims. All patients who presented to participating emergency departments underwent clinical evaluation before radiographic imaging. The presence or absence of the following criteria was noted: midline Cervical tenderness, altered level of alertness, evidence of intoxication, neurologic abnormality, and presence of painful distracting Injury. Presence or absence of each individual criterion was documented for each patient before radiographic imaging, unless the patient was judged to be too unstable to complete the clinical evaluation before radiographs. The decision to radiograph a patient was entirely at the physician9s discretion and not driven by the NEXUS questionnaire. The presence or absence of CSI was based on the final interpretation of all radiographic studies. Data on all patients who were younger than 18 years were sequestered from the main database for separate analysis. Results. There were 3065 patients (9.0% of all NEXUS patients) who were younger than 18 years in this cohort, 30 of whom (0.98%) sustained a CSI. Included in the study were 88 children who were younger than 2, 817 who were between 2 and 8, and 2160 who were 8 to 17. Fractures of the lower Cervical vertebrae (C5–C7) accounted for 45.9% of pediatric CSIs. No case of spinal cord Injury without radiographic abnormality was reported in any child in this study, although 22 cases were reported in adults. Only 4 of the 30 injured children were younger than 9 years, and none was younger than 2 years. Tenderness and distracting Injury were the 2 most common abnormalities noted in patients with and without CSI. The decision rule correctly identified all pediatric CSI victims (sensitivity: 100.0%; 95% confidence interval: 87.8%–100.0%) and correctly designated 603 patients as low risk for CSI (negative predictive value: 100.0%; 95% confidence interval: 99.4%–100.0%). Conclusions. The lower Cervical Spine is the most common site of CSI in children, and fractures are the most common type of Injury. CSI is rare among patients aged 8 years or younger. The NEXUS decision instrument performed well in children, and its use could reduce pediatric Cervical Spine imaging by nearly 20%. However, the small number of infants and toddlers in the study suggests caution in applying the NEXUS criteria to this particular age group.
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a prospective multicenter study of Cervical Spine Injury in children
2001Co-Authors: Peter Viccellio, William R Mower, Harold K Simon, Barry D Pressman, Manish N Shah, Jerome R. HoffmanAbstract:Objective. Pediatric victims of blunt trauma have developmental and anatomic characteristics that can make it difficult to assess their risk of Cervical Spine Injury (CSI). Previous reports, all retrospective in nature, have not identified any cases of CSI in either children or adults in the absence of neck pain, neurologic symptoms, distracting Injury, or altered mental status. The objective of this study was to examine the incidence and spectrum of Spine Injury in patients who are younger than 18 years and to evaluate the efficacy of the National Emergency X-Radiography Utilization Study (NEXUS) decision instrument for obtaining Cervical Spine radiog- raphy in pediatric trauma victims. Methods. We performed a prospective, multicenter study to evaluate pediatric blunt trauma victims. All patients who presented to participating emergency de- partments underwent clinical evaluation before radio- graphic imaging. The presence or absence of the follow- ing criteria was noted: midline Cervical tenderness, altered level of alertness, evidence of intoxication, neu- rologic abnormality, and presence of painful distracting Injury. Presence or absence of each individual criterion was documented for each patient before radiographic imaging, unless the patient was judged to be too unstable to complete the clinical evaluation before radiographs. The decision to radiograph a patient was entirely at the physician's discretion and not driven by the NEXUS questionnaire. The presence or absence of CSI was based on the final interpretation of all radiographic studies. Data on all patients who were younger than 18 years were sequestered from the main database for separate analysis. Results. There were 3065 patients (9.0% of all NEXUS patients) who were younger than 18 years in this cohort, 30 of whom (0.98%) sustained a CSI. Included in the study were 88 children who were younger than 2, 817 who were between 2 and 8, and 2160 who were 8 to 17. Fractures of the lower Cervical vertebrae (C5-C7) ac- counted for 45.9% of pediatric CSIs. No case of spinal cord Injury without radiographic abnormality was re- ported in any child in this study, although 22 cases were reported in adults. Only 4 of the 30 injured children were younger than 9 years, and none was younger than 2 years. Tenderness and distracting Injury were the 2 most com- mon abnormalities noted in patients with and without CSI. The decision rule correctly identified all pediatric CSI victims (sensitivity: 100.0%; 95% confidence interval: 87.8%-100.0%) and correctly designated 603 patients as low risk for CSI (negative predictive value: 100.0%; 95% confidence interval: 99.4%-100.0%). Conclusions. The lower Cervical Spine is the most common site of CSI in children, and fractures are the most common type of Injury. CSI is rare among patients aged 8 years or younger. The NEXUS decision instru- ment performed well in children, and its use could re- duce pediatric Cervical Spine imaging by nearly 20%. However, the small number of infants and toddlers in the study suggests caution in applying the NEXUS crite- ria to this particular age group. Pediatrics 2001;108(2). URL: http://www.pediatrics.org/cgi/content/full/108/2/ e20; Cervical Spine, radiography, Injury, pediatric.
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distribution and patterns of blunt traumatic Cervical Spine Injury
2001Co-Authors: William Goldberg, Stefan Tigges, Jerome R. Hoffman, Charles F Mueller, Edward A Panacek, William R MowerAbstract:STUDY OBJECTIVE: Previous studies of Cervical Spine Injury involve individual institutions or special populations. There is currently little reliable information regarding natural Cervical Spine Injury patterns after blunt trauma. This substudy of the National Emergency X-Radiography Utilization Study project was designed to accurately assess the prevalence, spectrum, and distribution of Cervical Spine Injury after blunt trauma. METHODS: We prospectively enrolled all patients with blunt trauma undergoing Cervical Spine radiography at 21 diverse institutions. Injury status was determined by review of all radiographic studies obtained on each patient. For each individual Injury, we recorded which specific films revealed the Injury, the level and location of Injury on each vertebra, and the age and sex of the patient. RESULTS: Of 34,069 enrolled patients with blunt trauma, 818 (2.4%) individuals had a total of 1,496 distinct Cervical Spine injuries to 1,285 different Cervical Spine structures. The second Cervical vertebra was the most common level of Injury (286 [24.0%] fractures, including 92 odontoid fractures), and 470 (39.3%) fractures occurred in the 2 lowest Cervical vertebrae (C6 and C7). The vertebral body, injured in 235 patients, was the most frequent site of fracture. Nearly one third of all injuries (29.3%) were considered clinically insignificant. CONCLUSION: Cervical Spine injuries occur in a small minority of patients with blunt trauma who undergo imaging. The atlantoaxial region is the most common site of Injury, and the sixth and seventh vertebrae are involved in over one third of all injuries. Other Spine levels are much more commonly involved than has previously been appreciated. A substantial minority of radiographically defined Cervical Spine injuries are of little clinical importance.
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interrater reliability of Cervical Spine Injury criteria in patients with blunt trauma
1998Co-Authors: Swaminatha V Mahadevan, Jerome R. Hoffman, William Goldberg, William R Mower, Neal Peeples, Richard SonnerAbstract:Abstract Study objective: To determine the interrater reliability of previously defined risk criteria for Cervical Spine Injury. Methods: Two emergency physicians independently evaluated patients with blunt trauma to determine whether they exhibited any of four risk criteria: (1) altered neurologic function; (2) evidence of intoxication; (3) spinous process or posterior midline Cervical tenderness; or (4) distracting painful Injury. Each criterion was explicitly described on study data forms. Physician concordance was measured, and the κ statistic was calculated, for the combined risk criteria (based on the presence of any individual criterion), and for each individual criterion. Results: There were 122 patients evaluated. Physicians agreed on overall classifications for 107 patients (87.7%; κ, .73; confidence interval [CI], .61 to .86). Agreement for individual criteria were as follows: (1) altered neurologic function–102 patients (83.6%; κ, .58; CI, .41 to .74); (2) intoxication–118 patients (96.7%; κ, .86; CI, .72 to .99); (3) posterior midline tenderness–109 patients (89.3%; κ, .77; CI, .65 to .89); (4) distracting Injury–112 patients (91.8%; κ, .77; CI, .64 to .91). Conclusion: The combined Cervical Spine Injury criteria have substantial interrater reliability. Individual criteria are slightly less reliable. [Mahadevan S, Mower WR, Hoffman JR, Peeples N, Goldberg W, Sonner R: Interrater reliability of Cervical Spine Injury criteria in patients with blunt trauma. Ann Emerg Med February 1998;31:197-201.]
Alexander R. Vaccaro - One of the best experts on this subject based on the ideXlab platform.
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updated return to play recommendations for collision athletes after Cervical Spine Injury a modified delphi consensus study with the Cervical Spine research society
2020Co-Authors: Gregory D Schroeder, Jose A Canseco, Parthik D Patel, Alan S Hilibrand, Christopher K Kepler, Srdjan M Mirkovic, Robert G Watkins, Andrew B Dossett, Andrew C Hecht, Alexander R. VaccaroAbstract:Background Previous studies have attempted to establish return-to-play (RTP) guidelines in collision sport athletes after Cervical Spine Injury; however, recommendations have been limited by scant high-quality evidence and basic consensus survey methodologies. Objective To create relevant clinical statements regarding management in collision sport athletes after Cervical Spine Injury, and establish consensus RTP recommendations. Methods Following the modified Delphi methodology, a 3 round survey study was conducted with Spine surgeons from the Cervical Spine Research Society and National Football League team physicians in order to establish consensus guidelines and develop recommendations for Cervical Spine Injury management in collision sport athletes. Results Our study showed strong consensus that asymptomatic athletes without increased magnetic resonance imaging (MRI) T2-signal changes following 1-/2- level anterior Cervical discectomy and fusion (ACDF) may RTP, but not after 3-level ACDF (84.4%). Although allowed RTP after 1-/2-level ACDF was noted in various scenarios, the decision was contentious. No consensus RTP for collision athletes after 2-level ACDF was noted. Strong consensus was achieved for RTP in asymptomatic athletes without increased signal changes and spinal canal diameter >10 mm (90.5%), as well as those with resolved MRI signal changes and diameter >13 mm (81.3%). No consensus was achieved in RTP for cases with pseudarthrosis following ACDF. Strong consensus supported a screening MRI before sport participation in athletes with a history of Cervical Spine Injury (78.9%). Conclusion This study provides modified Delphi process consensus statements regarding Cervical Spine Injury management in collision sport athletes from leading experts in Spine surgery, sports injuries, and Cervical trauma. Future research should aim to elucidate optimal timelines for RTP, as well as focus on prevention of injuries.
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application of aoSpine subaxial Cervical Spine Injury classification in simple and complex cases
2017Co-Authors: Bizhan Aarabi, Alexander R. Vaccaro, Cumhur Oner, Gregory D Schroeder, Noori AkhtardaneshAbstract:INTRODUCTION Cervical Spine Injury classification systems should be simple, easy to relate and remember, reliable guide for surgical planning, and predictor of outcome in clinical settings. We investigated whether the AOSpine subaxial Cervical Spine classification system predicted Injury severity and neurologic outcome. MATERIAL AND METHODS We analyzed the relevant clinical, imaging, management, and American Spinal Injury Association (ASIA) impairment scale (AIS) grade conversion of 92 AIS grades A-C patients with Cervical Spine Injury. We correlated morphology class with age, Injury severity score (ISS), follow-up ASIA motor score (AMS), intramedullary lesion length (IMLL), and AIS grade conversion at 6 months after Injury. RESULTS The mean age of patients was 39.3 years, 83 were men, and 69 were injured during an automobile accident or after a fall. The AOSpine class was A4 in 8, B2 in 5, B2A4 in 16, B3 in 19, and C in 44 patients. The mean ISS was 29.7 and AMS was 17.1. AIS grade was A in 48, B in 25, and C in 19 patients. Mean IMLL on postoperative magnetic resonance imaging was 72 mm: A4 = 68.1; B2A4 = 86.5; B2 = 59.3; B3 = 46.8; and C = 79.9. At a mean follow-up of 6 months, the mean AMS was 39.6. Compared to patients with class B3 injuries, those with class C injuries were significantly younger (P < 0.0001), had longer IMLL (P < 0.002), and were less likely to have AIS grade conversion to a better grade (P < 0.02). CONCLUSIONS The AOSpine subaxial Cervical Spine Injury classification system successfully predicted Injury severity (longer IMLL) and chances of neurologic recovery (AIS grade conversion) across different class subtypes.
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aoSpine subaxial Cervical Spine Injury classification system
2016Co-Authors: Alexander R. Vaccaro, John D Koerner, Kris E Radcliff, Cumhur F Oner, M Reinhold, Klaus J Schnake, Frank Kandziora, Michael G Fehlings, Marcel F Dvorak, Bizhan AarabiAbstract:This project describes a morphology-based subaxial Cervical Spine traumatic Injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes. A subaxial Cervical Spine Injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients (κ) were calculated for intraobserver and interobserver reliability. The classification system is based on three Injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all Injury subtypes (κ = 0.75 and 0.64, respectively). The AOSpine subaxial Cervical Spine Injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.
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Cervical Spine Injury severity score assessment of reliability
2007Co-Authors: Paul A. Anderson, Alexander R. Vaccaro, Christopher M. Bono, Timothy A Moore, Kirkland W Davis, Robert W Molinari, Daniel K Resnick, John R Dimar, Bizhan Aarabi, Glen LeversonAbstract:Background: Systems for classifying Cervical Spine Injury most commonly use mechanistic or morphologic terms and do not quantify the degree of stability. Along with neurologic function, stability is a major determinant of treatment and prognosis. The goal of our study was to investigate the reliability of a method of quantifying the stability of subaxial (C3-C7) Cervical Spine injuries. Methods: A quantitative system was developed in which an analog score of 0 to 5 points is assigned, on the basis of fracture displacement and severity of ligamentous Injury, to each of four spinal columns (anterior, posterior, right pillar, and left pillar). The total possible score thus ranges from 0 to 20 points. Fifteen examiners assigned scores after reviewing the plain radiographs and computed tomography images of thirty-four consecutive patients with Cervical Spine injuries. The scores were then evaluated for interobserver and intraobserver reliability with use of intraclass correlation coefficients. Results: The mean intraobserver and interobserver intraclass correlation coefficients for the fifteen reviewers were 0.977 and 0.883, respectively. Association between the scores and clinical data was also excellent, as all patients who had a score of ≥7 points had surgery. Similarly, eleven of the fourteen patients with a score of ≥7 points had a neurologic deficit compared with only three of the twenty with a score of <7 points. Conclusions: The Cervical Spine Injury Severity Score had excellent intraobserver and interobserver reliability. We believe that quantifying stability on the basis of fracture morphology will allow surgeons to better characterize these injuries and ultimately lead to the development of treatment algorithms that can be tested in clinical trials.
Bizhan Aarabi - One of the best experts on this subject based on the ideXlab platform.
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application of aoSpine subaxial Cervical Spine Injury classification in simple and complex cases
2017Co-Authors: Bizhan Aarabi, Alexander R. Vaccaro, Cumhur Oner, Gregory D Schroeder, Noori AkhtardaneshAbstract:INTRODUCTION Cervical Spine Injury classification systems should be simple, easy to relate and remember, reliable guide for surgical planning, and predictor of outcome in clinical settings. We investigated whether the AOSpine subaxial Cervical Spine classification system predicted Injury severity and neurologic outcome. MATERIAL AND METHODS We analyzed the relevant clinical, imaging, management, and American Spinal Injury Association (ASIA) impairment scale (AIS) grade conversion of 92 AIS grades A-C patients with Cervical Spine Injury. We correlated morphology class with age, Injury severity score (ISS), follow-up ASIA motor score (AMS), intramedullary lesion length (IMLL), and AIS grade conversion at 6 months after Injury. RESULTS The mean age of patients was 39.3 years, 83 were men, and 69 were injured during an automobile accident or after a fall. The AOSpine class was A4 in 8, B2 in 5, B2A4 in 16, B3 in 19, and C in 44 patients. The mean ISS was 29.7 and AMS was 17.1. AIS grade was A in 48, B in 25, and C in 19 patients. Mean IMLL on postoperative magnetic resonance imaging was 72 mm: A4 = 68.1; B2A4 = 86.5; B2 = 59.3; B3 = 46.8; and C = 79.9. At a mean follow-up of 6 months, the mean AMS was 39.6. Compared to patients with class B3 injuries, those with class C injuries were significantly younger (P < 0.0001), had longer IMLL (P < 0.002), and were less likely to have AIS grade conversion to a better grade (P < 0.02). CONCLUSIONS The AOSpine subaxial Cervical Spine Injury classification system successfully predicted Injury severity (longer IMLL) and chances of neurologic recovery (AIS grade conversion) across different class subtypes.
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aoSpine subaxial Cervical Spine Injury classification system
2016Co-Authors: Alexander R. Vaccaro, John D Koerner, Kris E Radcliff, Cumhur F Oner, M Reinhold, Klaus J Schnake, Frank Kandziora, Michael G Fehlings, Marcel F Dvorak, Bizhan AarabiAbstract:This project describes a morphology-based subaxial Cervical Spine traumatic Injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes. A subaxial Cervical Spine Injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients (κ) were calculated for intraobserver and interobserver reliability. The classification system is based on three Injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all Injury subtypes (κ = 0.75 and 0.64, respectively). The AOSpine subaxial Cervical Spine Injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.
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Cervical Spine Injury severity score assessment of reliability
2007Co-Authors: Paul A. Anderson, Alexander R. Vaccaro, Christopher M. Bono, Timothy A Moore, Kirkland W Davis, Robert W Molinari, Daniel K Resnick, John R Dimar, Bizhan Aarabi, Glen LeversonAbstract:Background: Systems for classifying Cervical Spine Injury most commonly use mechanistic or morphologic terms and do not quantify the degree of stability. Along with neurologic function, stability is a major determinant of treatment and prognosis. The goal of our study was to investigate the reliability of a method of quantifying the stability of subaxial (C3-C7) Cervical Spine injuries. Methods: A quantitative system was developed in which an analog score of 0 to 5 points is assigned, on the basis of fracture displacement and severity of ligamentous Injury, to each of four spinal columns (anterior, posterior, right pillar, and left pillar). The total possible score thus ranges from 0 to 20 points. Fifteen examiners assigned scores after reviewing the plain radiographs and computed tomography images of thirty-four consecutive patients with Cervical Spine injuries. The scores were then evaluated for interobserver and intraobserver reliability with use of intraclass correlation coefficients. Results: The mean intraobserver and interobserver intraclass correlation coefficients for the fifteen reviewers were 0.977 and 0.883, respectively. Association between the scores and clinical data was also excellent, as all patients who had a score of ≥7 points had surgery. Similarly, eleven of the fourteen patients with a score of ≥7 points had a neurologic deficit compared with only three of the twenty with a score of <7 points. Conclusions: The Cervical Spine Injury Severity Score had excellent intraobserver and interobserver reliability. We believe that quantifying stability on the basis of fracture morphology will allow surgeons to better characterize these injuries and ultimately lead to the development of treatment algorithms that can be tested in clinical trials.
Cumhur F Oner - One of the best experts on this subject based on the ideXlab platform.
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establishing the Injury severity of subaxial Cervical Spine trauma validating the hierarchical nature of the ao Spine subaxial Cervical Spine Injury classification system
2021Co-Authors: Gregory D Schroeder, Cumhur F Oner, Klaus J Schnake, Frank Kandziora, Jose A Canseco, Parthik D Patel, Srikanth N Divi, Brian A Karamian, Emiliano Neves Vialle, Marcel DvorakAbstract:STUDY DESIGN Global cross-sectional survey. OBJECTIVE 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. SUMMARY OF BACKGROUND DATA 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: (1) Injury morphology, (2) facet Injury involvement, (3) neurologic status, and (4) case-specific modifiers. METHODS 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. RESULTS 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 2 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. CONCLUSIONS 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.
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aoSpine subaxial Cervical Spine Injury classification system
2016Co-Authors: Alexander R. Vaccaro, John D Koerner, Kris E Radcliff, Cumhur F Oner, M Reinhold, Klaus J Schnake, Frank Kandziora, Michael G Fehlings, Marcel F Dvorak, Bizhan AarabiAbstract:This project describes a morphology-based subaxial Cervical Spine traumatic Injury classification system. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra- and interobserver reliability to be used for clinical and research purposes. A subaxial Cervical Spine Injury classification system was developed using a consensus process among clinical experts. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients (κ) were calculated for intraobserver and interobserver reliability. The classification system is based on three Injury morphology types similar to the TL system: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Intraobserver and interobserver reliability was substantial for all Injury subtypes (κ = 0.75 and 0.64, respectively). The AOSpine subaxial Cervical Spine Injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for communication, patient care and for research purposes.
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Cervical Spine Injury in the young child
2012Co-Authors: Cumhur F Oner, Navin N Ramrattan, Bronek M Boszczyk, Rene M Castelein, Paul F HeiniAbstract:This Grand Rounds is about the clinical and radiological presentation, treatment and outcome of pediatric Cervical Spine Injury. A 15-month-old girl suffers from a motor vehicle accident and is intubated on-site because of progressive agitation. Whole body trauma CT was read as normal. When sedation was discontinued after 24 h she was found to be tetraplegic below C6 level. MRI shows a total disruption between C6 and C7 that in hindsight was also visible on the initial trauma CT. She was treated surgically by an anterior and posterior reconstruction and was post-operatively treated with a halo vest. Clearing the Cervical Spine in young children is deceptively difficult. Meticulous review and interpretation of conventional radiographs and CT are important yet MRI should be considered in uncertain cases. Severe ligamentous Injury without concomitant bony Injury occurs more frequently than in older children and adults, with sometimes devastating consequences.