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Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons

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Abstract

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.

Methods

A previously described classification system of thoracolumbar injuries which consists of a morphologic classification of the fracture, a grading system for the neurologic status and relevant patient-specific modifiers was applied to 25 cases by 100 spinal surgeons from across the world twice independently, in grading sessions 1 month apart. The results were analyzed for classification reliability using the Kappa coefficient (κ).

Results

The overall Kappa coefficient for all cases was 0.56, which represents moderate reliability. Kappa values describing interobserver agreement were 0.80 for type A injuries, 0.68 for type B injuries and 0.72 for type C injuries, all representing substantial reliability. The lowest level of agreement for specific subtypes was for fracture subtype A4 (Kappa = 0.19). Intraobserver analysis demonstrated overall average Kappa statistic for subtype grading of 0.68 also representing substantial reproducibility.

Conclusion

In a worldwide sample of spinal surgeons without previous exposure to the recently described AOSpine Thoracolumbar Spine Injury Classification System, we demonstrated moderate interobserver and substantial intraobserver reliability. These results suggest that most spine surgeons can reliably apply this system to spine trauma patients as or more reliably than previously described systems.

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Conflict of interest

AOSpine is a clinical division of the AO Foundation—an independent medically guided not for profit organization. The AO has a strong financial independence thanks to the foundations endowment. The annual operating activities are financed through three pillars: Collaboration and support agreements with DePuy Synthes and other industrial partners, return on own financial assets and other third party income (e.g. participant fees, R&D projects, memberships).

The AOSpine Knowledge Forums are pathology focused working groups acting on behalf of AOSpine in their domain of scientific expertise. Each forum consists of a steering committee of up to 10 international spine experts who meet biannually to discuss research, assess the best evidence for current practices and formulate clinical trials to advance their field of spine expertise. Authors are compensated for their travel and accommodation costs. Study support is provided directly through AOSpine’s Research department and AO’s Clinical Investigation and Documentation unit. There are no other institutional subsidies, corporate affiliations or funding sources supporting this work unless clearly documented and disclosed.

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Authors and Affiliations

  1. Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Christopher K. Kepler, Alexander R. Vaccaro, John D. Koerner & Gregory D. Schroeder

  2. University of Toronto Spine Program and Toronto Western Hospital, Toronto, ON, Canada

    Michael G. Fehlings

  3. University of British Columbia, Vancouver, BC, Canada

    Marcel F. Dvorak

  4. Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Friedberger Landstrasse 430, 60389, Frankfurt, Germany

    Frank Kandziora

  5. Ganga Hospital, Coimbatore, Tamil Nadu, India

    Shanmuganathan Rajasekaran

  6. University of Maryland Medical Center, College Park, MD, USA

    Bizhan Aarabi

  7. Catholic University of Parana, Curitiba, Brazil

    Luiz R. Vialle

  8. Klinikum Suedstadt Rostock, Department of Orthopaedic and Trauma Surgery, Suedring 81, 18059, Rostock, Germany

    Maximilian Reinhold

  9. Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstrasse 430, 60389, Frankfurt/Main, Germany

    Klaus John Schnake

  10. Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359798, Seattle, WA, 98104, USA

    Carlo Bellabarba

  11. School of Medicine, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands

    F. Cumhur Öner

Authors
  1. Christopher K. Kepler
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  2. Alexander R. Vaccaro
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  3. John D. Koerner
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  4. Marcel F. Dvorak
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  5. Frank Kandziora
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  6. Shanmuganathan Rajasekaran
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  7. Bizhan Aarabi
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  8. Luiz R. Vialle
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  9. Michael G. Fehlings
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  10. Gregory D. Schroeder
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  11. Maximilian Reinhold
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  12. Klaus John Schnake
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  13. Carlo Bellabarba
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  14. F. Cumhur Öner
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Corresponding author

Correspondence to Gregory D. Schroeder.

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Kepler, C.K., Vaccaro, A.R., Koerner, J.D. et al. Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons. Eur Spine J 25, 1082–1086 (2016). https://doi.org/10.1007/s00586-015-3765-9

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  • DOI: https://doi.org/10.1007/s00586-015-3765-9

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