• 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, and Luiz R Vialle.
• Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA. alexvaccaro3@aol.com.
• Eur Spine J. 2016 Jul 1; 25 (7): 2173-84.

PurposeThis 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.MethodsA 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.ResultsThe 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).ConclusionsThe 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.

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