• Christopher K Kepler, Alexander R Vaccaro, John D Koerner, Marcel F Dvorak, Frank Kandziora, Shanmuganathan Rajasekaran, Bizhan Aarabi, Luiz R Vialle, Michael G Fehlings, Gregory D Schroeder, Maximilian Reinhold, Klaus John Schnake, Carlo Bellabarba, and Cumhur ÖnerFFSchool of Medicine, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands..
• Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
• Eur Spine J. 2016 Apr 1; 25 (4): 1082-6.

PurposeThe 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.MethodsA 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).ResultsThe 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.ConclusionIn 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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