Document Type
Article
Publication Date
8-19-2022
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.
Recommended Citation
Lambrechts, Mark J.; Schroeder, Gregory D.; Karamian, Brian A; Canseco, Jose A; Oner, F Cumhur; Benneker, Lorin M; Bransford, Richard J; Kandziora, Frank; Rajasekaran, Shanmuganathan; El-Sharkawi, Mohammad; Kanna, Rishi; Joaquim, Andrei Fernandes; Schnake, Klaus; Kepler, Christopher K; Vaccaro, Alex R.; AO Spine Upper Cervical Injury Classification International Members; and AO Spine Upper Cervical Injury Classification International Members, "Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System" (2022). Rothman Institute Faculty Papers. Paper 186.
https://jdc.jefferson.edu/rothman_institute/186
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Language
English
Comments
This article is the author’s final published version in Journal of neurosurgery. Spine, Volume 38, Issue 1, August 2022, Pages 31 - 41.
The published version is available at https://doi.org/10.3171/2022.6.SPINE22454. Copyright © Lambrechts et al.