Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System.

Authors

• Mark J Lambrechts
• Gregory D Schroeder
• Brian A Karamian
• Jose A Canseco
• F Cumhur Oner
• Lorin M Benneker
• Richard J Bransford
• Frank Kandziora
• Shanmuganathan Rajasekaran
• Mohammad El-Sharkawi
• Rishi Kanna
• Andrei Fernandes Joaquim
• Klaus Schnake
• Christopher K Kepler
• Alexander R Vaccaro

Publication/Presentation Date

1-1-2023

Abstract

OBJECTIVE: The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery).

METHODS: A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility.

RESULTS: The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36).

CONCLUSIONS: The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

Volume

38

Issue

1

First Page

31

Last Page

41

ISSN

1547-5646

Published In/Presented At

Lambrechts, M. J., Schroeder, G. D., Karamian, B. A., Canseco, J. A., Oner, F. C., Benneker, L. M., Bransford, R. J., Kandziora, F., Rajasekaran, S., El-Sharkawi, M., Kanna, R., Joaquim, A. F., Schnake, K., Kepler, C. K., Vaccaro, A. R., AO Spine Upper Cervical Injury Classification International Members, & AO Spine Upper Cervical Injury Classification International Members (2022). Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System. Journal of neurosurgery. Spine, 38(1), 31–41. https://doi.org/10.3171/2022.6.SPINE22454

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

35986731

Department(s)

Administration and Leadership

Document Type

Article