The Experts below are selected from a list of 16293 Experts worldwide ranked by ideXlab platform
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
Neurosurgery, 2020Co-Authors: Gregory D Schroeder, Christopher K Kepler, Jose A Canseco, Parthik D Patel, Alan S Hilibrand, 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
Journal of Orthopaedic Trauma, 2017Co-Authors: Bizhan Aarabi, Alexander R. Vaccaro, Gregory D Schroeder, Cumhur Oner, 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
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Cumhur F Oner, Frank Kandziora, John D Koerner, Max Reinhold, Klaus J Schnake, Marcel F Dvorak, Michael G Fehlings, Kris E Radcliff, 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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the surgical algorithm for the aoSpine thoracolumbar Spine Injury classification system
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Gregory D Schroeder, Christopher K Kepler, Cumhur F Oner, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Mark F Kurd, Max Reinhold, Klaus J SchnakeAbstract:Purpose The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar Spine Injury classification system.
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reliability analysis of the aoSpine thoracolumbar Spine Injury classification system by a worldwide group of naive spinal surgeons
European Spine Journal, 2016Co-Authors: Christopher K Kepler, Alexander R. Vaccaro, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Marcel F Dvorak, Michael G Fehlings, Bizhan Aarabi, Shanmuganathan Rajasekaran, Gregory D SchroederAbstract:Purpose The aims of this study were (1) to demonstrate the AOSpine thoracolumbar Spine Injury classification system can be reliably applied by an international group of surgeons and (2) to delineate those Injury types which are difficult for Spine surgeons to classify reliably.
Gregory D Schroeder - 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
Spine, 2021Co-Authors: Gregory D Schroeder, Cumhur F Oner, Frank Kandziora, Klaus J Schnake, 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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updated return to play recommendations for collision athletes after cervical Spine Injury a modified delphi consensus study with the cervical Spine research society
Neurosurgery, 2020Co-Authors: Gregory D Schroeder, Christopher K Kepler, Jose A Canseco, Parthik D Patel, Alan S Hilibrand, 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
Journal of Orthopaedic Trauma, 2017Co-Authors: Bizhan Aarabi, Alexander R. Vaccaro, Gregory D Schroeder, Cumhur Oner, 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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the surgical algorithm for the aoSpine thoracolumbar Spine Injury classification system
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Gregory D Schroeder, Christopher K Kepler, Cumhur F Oner, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Mark F Kurd, Max Reinhold, Klaus J SchnakeAbstract:Purpose The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar Spine Injury classification system.
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reliability analysis of the aoSpine thoracolumbar Spine Injury classification system by a worldwide group of naive spinal surgeons
European Spine Journal, 2016Co-Authors: Christopher K Kepler, Alexander R. Vaccaro, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Marcel F Dvorak, Michael G Fehlings, Bizhan Aarabi, Shanmuganathan Rajasekaran, Gregory D SchroederAbstract:Purpose The aims of this study were (1) to demonstrate the AOSpine thoracolumbar Spine Injury classification system can be reliably applied by an international group of surgeons and (2) to delineate those Injury types which are difficult for Spine surgeons to classify reliably.
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
Spine, 2021Co-Authors: Gregory D Schroeder, Cumhur F Oner, Frank Kandziora, Klaus J Schnake, 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
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Cumhur F Oner, Frank Kandziora, John D Koerner, Max Reinhold, Klaus J Schnake, Marcel F Dvorak, Michael G Fehlings, Kris E Radcliff, 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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the surgical algorithm for the aoSpine thoracolumbar Spine Injury classification system
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Gregory D Schroeder, Christopher K Kepler, Cumhur F Oner, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Mark F Kurd, Max Reinhold, Klaus J SchnakeAbstract:Purpose The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar Spine Injury classification system.
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the surgical algorithm for the aoSpine thoracolumbar Spine Injury classification system
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Gregory D Schroeder, Christopher K Kepler, Cumhur F Oner, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Mark F Kurd, Max Reinhold, Klaus J SchnakeAbstract:Purpose The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar Spine Injury classification system. Methods A survey was sent to AOSpine members from the six AO regions of the world, and surgeons were asked if a patient should undergo an initial trial of conservative management or if surgical management was warranted. The survey consisted of controversial Injury patterns. Using the results of the survey, a surgical algorithm was developed. Results The AOSpine Trauma Knowledge forum defined that the injuries in which less than 30 % of surgeons would recommend surgical intervention should undergo a trial of non-operative care, and injuries in which 70 % of surgeons would recommend surgery should undergo surgical intervention. Using these thresholds, it was determined that injuries with a thoracolumbar AOSpine Injury score (TL AOSIS) of three or less should undergo a trial of conservative treatment, and injuries with a TL AOSIS of more than five should undergo surgical intervention. Operative or non-operative treatment is acceptable for injuries with a TL AOSIS of four or five. Conclusion The current algorithm uses a meaningful Injuryclassificationandworldwidesurgeoninputtodetermine the initial treatment recommendation for thoracolumbar injuries. This allows for a globally accepted surgical algorithm for the treatment of thoracolumbar trauma.
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the influence of Spine surgeons experience on the classification and intraobserver reliability of the novel aoSpine thoracolumbar Spine Injury classification system an international study
Spine, 2015Co-Authors: Said Sadiqi, Gregory D Schroeder, Cumhur F Oner, Marcel F Dvorak, Bizhan Aarabi, Alexander R. VaccaroAbstract:Study Design. International validation study. Objective. To investigate the influence of the Spine surgeons' level of experience on the intraobserver reliability of the novel AOSpine Thoracolumbar Spine Injury Classification system, and the appropriate classification according to this system. Summary of Background Data. Wide variability has been demonstrated for intraobserver reliability of the AOSpine classification system. The Spine surgeons' level of experience may play a crucial role in the appropriate classification of thoracolumbar fractures, and the degree of reproducibility of the same observer on separate occasions. However, this has not been previously investigated. Methods. After a training on the classification system, high quality CT images together with clinical data from 25 patients with thoracolumbar fractures were independently assessed by 100 Spine surgeons from across the world on 2 different occasions, 1 month apart from each other. The Spine surgeons were allocated to a subgroup, according to their years of experience. Intraobserver reliability was calculated for each individual surgeon and for each subgroup, using the Kappa statistics (k). Descriptive statistics was used to describe any differences between the subgroups. Analysis of any misclassifications was performed by calculating sensitivity and specificity estimates. Results. Almost all surgeons demonstrated at least moderate intraobserver reliability. All surgeon subgroups demonstrated substantial reliability (κ=0.67-0.69) for fracture subtype grading, and almost all subgroups demonstrated excellent reliability (κ=0.79-0.83) for fracture morphology type regardless of subtype identified. In general, the fractures were most frequently misclassified by the most experienced surgeons. No major differences were observed among the subgroups when comparing the sensitivity and specificity rates. Conclusion. This international study demonstrated that the Spine surgeons' level of experience does not substantially influence the classification and intraobserver reliability of the recently described AOSpine Thoracolumbar Spine Injury Classification System.
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
Journal of Orthopaedic Trauma, 2017Co-Authors: Bizhan Aarabi, Alexander R. Vaccaro, Gregory D Schroeder, Cumhur Oner, 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
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Cumhur F Oner, Frank Kandziora, John D Koerner, Max Reinhold, Klaus J Schnake, Marcel F Dvorak, Michael G Fehlings, Kris E Radcliff, 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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reliability analysis of the aoSpine thoracolumbar Spine Injury classification system by a worldwide group of naive spinal surgeons
European Spine Journal, 2016Co-Authors: Christopher K Kepler, Alexander R. Vaccaro, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Marcel F Dvorak, Michael G Fehlings, Bizhan Aarabi, Shanmuganathan Rajasekaran, Gregory D SchroederAbstract:Purpose The aims of this study were (1) to demonstrate the AOSpine thoracolumbar Spine Injury classification system can be reliably applied by an international group of surgeons and (2) to delineate those Injury types which are difficult for Spine surgeons to classify reliably.
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the influence of Spine surgeons experience on the classification and intraobserver reliability of the novel aoSpine thoracolumbar Spine Injury classification system an international study
Spine, 2015Co-Authors: Said Sadiqi, Gregory D Schroeder, Cumhur F Oner, Marcel F Dvorak, Bizhan Aarabi, Alexander R. VaccaroAbstract:Study Design. International validation study. Objective. To investigate the influence of the Spine surgeons' level of experience on the intraobserver reliability of the novel AOSpine Thoracolumbar Spine Injury Classification system, and the appropriate classification according to this system. Summary of Background Data. Wide variability has been demonstrated for intraobserver reliability of the AOSpine classification system. The Spine surgeons' level of experience may play a crucial role in the appropriate classification of thoracolumbar fractures, and the degree of reproducibility of the same observer on separate occasions. However, this has not been previously investigated. Methods. After a training on the classification system, high quality CT images together with clinical data from 25 patients with thoracolumbar fractures were independently assessed by 100 Spine surgeons from across the world on 2 different occasions, 1 month apart from each other. The Spine surgeons were allocated to a subgroup, according to their years of experience. Intraobserver reliability was calculated for each individual surgeon and for each subgroup, using the Kappa statistics (k). Descriptive statistics was used to describe any differences between the subgroups. Analysis of any misclassifications was performed by calculating sensitivity and specificity estimates. Results. Almost all surgeons demonstrated at least moderate intraobserver reliability. All surgeon subgroups demonstrated substantial reliability (κ=0.67-0.69) for fracture subtype grading, and almost all subgroups demonstrated excellent reliability (κ=0.79-0.83) for fracture morphology type regardless of subtype identified. In general, the fractures were most frequently misclassified by the most experienced surgeons. No major differences were observed among the subgroups when comparing the sensitivity and specificity rates. Conclusion. This international study demonstrated that the Spine surgeons' level of experience does not substantially influence the classification and intraobserver reliability of the recently described AOSpine Thoracolumbar Spine Injury Classification System.
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establishing the Injury severity of thoracolumbar trauma confirmation of the hierarchical structure of the aoSpine thoracolumbar Spine Injury classification system
Global Spine Journal, 2015Co-Authors: Gregory D Schroeder, Alexander R. Vaccaro, Christopher K Kepler, Luiz Roberto Vialle, John D Koerner, Marcel F Dvorak, Cumhur Oner, Bizhan Aarabi, Carlo Bellabarba, Michael G FehlingsAbstract:IntroductionThe AOSpine Thoracolumbar Spine Injury Classification System was recently published and combines elements of both the Magerl system and the Thoracolumbar Injury Classification System (T...
Klaus J Schnake - 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
Spine, 2021Co-Authors: Gregory D Schroeder, Cumhur F Oner, Frank Kandziora, Klaus J Schnake, 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
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Cumhur F Oner, Frank Kandziora, John D Koerner, Max Reinhold, Klaus J Schnake, Marcel F Dvorak, Michael G Fehlings, Kris E Radcliff, 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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the surgical algorithm for the aoSpine thoracolumbar Spine Injury classification system
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Gregory D Schroeder, Christopher K Kepler, Cumhur F Oner, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Mark F Kurd, Max Reinhold, Klaus J SchnakeAbstract:Purpose The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar Spine Injury classification system.
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the surgical algorithm for the aoSpine thoracolumbar Spine Injury classification system
European Spine Journal, 2016Co-Authors: Alexander R. Vaccaro, Gregory D Schroeder, Christopher K Kepler, Cumhur F Oner, Luiz Roberto Vialle, Frank Kandziora, John D Koerner, Mark F Kurd, Max Reinhold, Klaus J SchnakeAbstract:Purpose The goal of the current study is to establish a surgical algorithm to accompany the AOSpine thoracolumbar Spine Injury classification system. Methods A survey was sent to AOSpine members from the six AO regions of the world, and surgeons were asked if a patient should undergo an initial trial of conservative management or if surgical management was warranted. The survey consisted of controversial Injury patterns. Using the results of the survey, a surgical algorithm was developed. Results The AOSpine Trauma Knowledge forum defined that the injuries in which less than 30 % of surgeons would recommend surgical intervention should undergo a trial of non-operative care, and injuries in which 70 % of surgeons would recommend surgery should undergo surgical intervention. Using these thresholds, it was determined that injuries with a thoracolumbar AOSpine Injury score (TL AOSIS) of three or less should undergo a trial of conservative treatment, and injuries with a TL AOSIS of more than five should undergo surgical intervention. Operative or non-operative treatment is acceptable for injuries with a TL AOSIS of four or five. Conclusion The current algorithm uses a meaningful Injuryclassificationandworldwidesurgeoninputtodetermine the initial treatment recommendation for thoracolumbar injuries. This allows for a globally accepted surgical algorithm for the treatment of thoracolumbar trauma.
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ao Spine Injury classification system a revision proposal for the thoracic and lumbar Spine
European Spine Journal, 2013Co-Authors: Max Reinhold, Klaus J Schnake, Carlo Bellabarba, Laurent Audige, Li Yang Dai, Cumhur F OnerAbstract:Purpose 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.