Reliability and reproducibility analysis of the AOSpine thoracolumbar spine injury classification system by Chinese spinal surgeons
- 309 Downloads
The objective of this study was to analyze the interobserver reliability and intraobserver reproducibility of the new AOSpine thoracolumbar spine injury classification system in young Chinese orthopedic surgeons with different levels of experience in spinal trauma. Previous reports suggest that the new AOSpine thoracolumbar spine injury classification system demonstrates acceptable interobserver reliability and intraobserver reproducibility. However, there are few studies in Asia, especially in China.
The AOSpine thoracolumbar spine injury classification system was applied to 109 patients with acute, traumatic thoracolumbar spinal injuries by two groups of spinal surgeons with different levels of clinical experience. The Kappa coefficient was used to determine interobserver reliability and intraobserver reproducibility.
The overall Kappa coefficient for all cases was 0.362, which represents fair reliability. The Kappa statistic was 0.385 for A-type injuries and 0.292 for B-type injuries, which represents fair reliability, and 0.552 for C-type injuries, which represents moderate reliability. The Kappa coefficient for intraobserver reproducibility was 0.442 for A-type injuries, 0.485 for B-type injuries, and 0.412 for C-type injuries. These values represent moderate reproducibility for all injury types. The raters in Group A provided significantly better interobserver reliability than Group B (P < 0.05). There were no between-group differences in intraobserver reproducibility.
This study suggests that the new AO spine injury classification system may be applied in day-to-day clinical practice in China following extensive training of healthcare providers. Further prospective studies in different healthcare providers and clinical settings are essential for validation of this classification system and to assess its utility.
KeywordsSpinal injury classification Thoracolumbar Consensus Reliability Reproducibility
Compliance with ethical standards
Conflict of interest
None of the authors has any potential conflict of interest.
- 2.Wood KB, Buttermann GR, Phukan R, Harrod CC, Mehbod A, Shannon B, Bono CM, Harris MB (2015) Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am 97:3–9CrossRefPubMedGoogle Scholar
- 4.Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 38:2028–2037CrossRefGoogle Scholar
- 8.Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, Harrop J, Dvorak M, Wood K, Fehlings MG, Fisher C, Zeiller SC, Anderson DG, Bono CM, Stock GH, Brown AK, Kuklo T, Oner FC (2005) A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976) 30:2325–2333CrossRefGoogle Scholar
- 9.Harrop JS, Vaccaro AR, Hurlbert RJ, Wilsey JT, Baron EM, Shaffrey CI, Fisher CG, Dvorak MF, Oner FC, Wood KB, Anand N, Anderson DG, Lim MR, Lee JY, Bono CM, Arnold PM, Rampersaud YR, Fehlings MG (2006) Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005. J Neurosurg Spine 4:118–122CrossRefPubMedGoogle Scholar
- 10.Rihn JA, Yang N, Fisher C, Saravanja D, Smith H, Morrison WB, Harrop J, Vacaro AR (2010) Using magnetic resonance imaging to accurately assess injury to the posterior ligamentous complex of the spine: a prospective comparison of the surgeon and radiologist. J Neurosurg Spine 12:391–396CrossRefPubMedGoogle Scholar
- 11.Kepler CK, Vaccaro AR, Koerner JD, Dvorak MF, Kandziora F, Rajasekaran S, Aarabi B, Vialle LR, Fehlings MG, Schroeder GD, Reinhold M, Schnake KJ, Bellabarba C, Cumhur Oner F (2016) Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naive spinal surgeons. Eur Spine J 25(4):1082–1086CrossRefPubMedGoogle Scholar
- 17.Blauth M, Bastian L, Knop C, Lange U, Tusch G (1999) Inter-observer reliability in the classification of thoraco-lumbar spinal injuries. Orthopade 28:662–681Google Scholar
- 21.Whang PG, Vaccaro AR, Poelstra KA, Patel AA, Anderson DG, Albert TJ, Hilibrand AS, Harrop JS, Sharan AD, Ratliff JK, Hurlbert RJ, Anderson P, Aarabi B, Sekhon LH, Gahr R, Carrino JA (2007) The influence of fracture mechanism and morphology on the reliability and validity of two novel thoracolumbar injury classification systems. Spine (Phila Pa 1976) 32:791–795CrossRefGoogle Scholar
- 24.Vaccaro AR, Rihn JA, Saravanja D, Anderson DG, Hilibrand AS, Albert TJ, Fehlings MG, Morrison W, Flanders AE, France JC, Arnold P, Anderson PA, Friel B, Malfair D, Street J, Kwon B, Paquette S, Boyd M, Dvorak MF, Fisher C (2009) Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine (Phila Pa 1976) 34(23):E841–E847. doi: 10.1097/BRS.0b013e3181bd11be CrossRefGoogle Scholar
- 25.Vaccaro AR, Lee JY, Schweitzer KM Jr, Lim MR, Baron EM, Oner FC, Hulbert RJ, Hedlund R, Fehlings MG, Arnold P, Harrop J, Bono CM, Anderson PA, Anderson DG, Harris MB (2006) Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma. Spine J 6:524–528CrossRefPubMedGoogle Scholar
- 28.Rajasekaran S, Vaccaro AR, Kanna RM, Schroeder GD, Oner FC, Vialle L, Chapman J, Dvorak M, Fehlings M, Shetty AP, Schnake K, Maheshwaran A, Kandziora F (2016) The value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries. Eur Spine J. doi: 10.1007/s00586-016-4623-0 Google Scholar
- 29.Sadiqi S, Oner FC, Dvorak MF, Aarabi B, Schroeder GD, Vaccaro AR (2015) 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 (Phila Pa 1976) 40:E1250–E1256CrossRefGoogle Scholar
- 31.Lee GY, Lee JW, Choi SW, Lim HJ, Sun HY, Kang Y, Chai JW, Kim S, Kang HS (2015) MRI inter-reader and intra-reader reliabilities for assessing injury morphology and posterior ligamentous complex integrity of the spine according to the Thoracolumbar Injury Classification System and Severity Score. Korean J Radiol 16:889–898CrossRefPubMedPubMedCentralGoogle Scholar