Reliability and safety of a new upper cervical spine injury treatment algorithm

ABSTRACT

In the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries.

Methods Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index.

Results The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases.

Conclusion The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.

RESUMO

Avaliamos a reprodutibilidade e segurança do algoritmo Upper Cervical Spine Injuries Treatment Algorithm (UCITA) recém proposto para a escolha do tratamento das lesões traumáticas da junção crânio-cervical.

Métodos Trinta casos previamente tratados de acordo com o algoritmo foram apresentados a quatro cirurgiões de coluna, sendo questionada a conduta pessoal dos mesmos e a conduta segundo a aplicação do algoritmo. Após 4 semanas, foram refeitas as mesmas perguntas para avaliar a reprodutibilidade (intra e interobservador) do algoritmo, através do índice estatístico “Kappa”.

Resultados A reprodutibilidade da conduta com o uso do algoritmo foi superior a reprodutibilidade da conduta pessoal dos cirurgiões. Com o uso do UCITA, a concordância do tratamento realmente efetivado foi encontrada em mais de 89% dos casos.

Conclusão O uso do UCITA foi seguro e reprodutível, podendo ser usado como ferramenta auxiliar na tomada de decisão entre tratamento cirúrgico versus conservador dos traumatismos da junção crâniocervical.

spinal injuries - spinal cord injuries - therapeutics - classification

traumatismos da coluna vertebral - traumatismos da medula espinal - terapêutica - classificação

• References

• 1 Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56(8):1663-74. http://doi.org/10.2106/00004623-197456080-00017
• 2 Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br. 1981;63-B(3):319-27.
• 3 Joaquim AF, Ghizoni E, Tedeschi H, Yacoub AR, Brodke DS, Vaccaro AR et al. Upper cervical injuries: clinical results using a new treatment algorithm. J Craniovertebr Junction Spine. 2015;6(1):16-20. http://doi.org/10.4103/0974-8237.151585
• 4 Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation: case report. J Neurosurg. 1986;65(6):863-70. http://doi.org/10.3171/jns.1986.65.6.0863
• 5 Menezes AH, Traynelis VC. Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). Childs Nerv Syst. 2008;24(10):1091-100. http://doi.org/10.1007/s00381-008-0606-8
• 6 Sances A, Jr., Myklebust JB, Maiman DJ, Larson SJ, Cusick JF, Jodat RW. The biomechanics of spinal injuries. Crit Rev Biomed Eng. 1984;11(1):1-76.
• 7 Lewis E, Liew S, Dowrick A. Risk factors for non-union in the non-operative management of type II dens fractures. ANZ J Surg. 2011;81(9):604-7. http://doi.org/10.1111/j.1445-2197.2010.05586.x
• 8 Middendorp JJ, Slooff WB, Nellestein WR, Oner FC. Incidence of and risk factors for complications associated with halo-vest immobilization: a prospective, descriptive cohort study of 239 patients. J Bone Joint Surg Am. 2009;91(1):71-9. http://doi.org/10.2106/JBJS.G.01347
• 9 Joaquim AF, Ghizoni E, Tedeschi H, Lawrence B, Brodke DS, Vaccaro AR et al. Upper cervical injuries - a rational approach to guide surgical management. J Spinal Cord Med. 2014;37(2):139-51. http://doi.org/10.1179/2045772313Y.201602000158
• 10 Anderson PA, Montesano PX. Morphology and treatment of occipital condyle fractures. Spine. 1988;13(7):731-6. http://doi.org/10.1097/00007632-198807000-00004
• 11 Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am. 1985;67(2):217-26. http://doi.org/10.2106/00004623-198567020-00007
• 12 Hays MB, Alker GJ, Jr. Fractures of the atlas vertebra. The two-part burst fracture of Jefferson. Spine. 1988;13(6):601-3. http://doi.org/10.1097/00007632-198813060-00001
• 13 Levine AM, Edwards CC. Fractures of the atlas. J Bone Joint Surg Am. 1991;73(5):680-91.
• 14 Grauer JN, Shafi B, Hilibrand AS, Harrop JS, Kwon BK, Beiner JM et al. Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J. 2005;5(2):123-9. http://doi.org/ 0.1016/j.spinee.2004.09.014
• 15 Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33(2):363-74. http://doi.org/10.2307/2529786
• 16 Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa M. Fractures of the C-2 vertebral body. J Neurosurg. 1994;81(2):206-12. http://doi.org/10.3171/jns.1994.81.2.0206
• 17 Fujimura Y, Nishi Y, Kobayashi K. Classification and treatment of axis body fractures. J Orthop Trauma. 1996;10(8):536-40. http://doi.org/10.1097/00005131-199611000-00005
• 18 Fielding JW, Hawkins RJ, Ratzan SA. Spine fusion for atlanto-axial instability. The J Bone Joint Surg Am. 1976;58(3):400-7. http://doi.org/10.2106/00004623-197658030-00020
• 19 Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Neurosurgery. 1997;41(2):368-376. http://doi.org/10.1097/00006123-199708000-00006