AOSpine subaxial cervical spine injury classification system.

Alexander R Vaccaro, John D Koerner, Kris E Radcliff, F Cumhur Oner, Maximilian Reinhold, Klaus J Schnake, Frank Kandziora, Michael G Fehlings, Marcel F Dvorak, Bizhan Aarabi, Shanmuganathan Rajasekaran, Gregory D Schroeder, Christopher K Kepler, Luiz R Vialle

European Spine Journal 2016 July

PURPOSE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.