An independent inter- and intra-observer agreement assessment of the AOSpine upper cervical injury classification system

BACKGROUND CONTEXT

The complex anatomy of the upper cervical spine resulted in numerous separate classification systems of upper cervical spine trauma. The AOSpine upper cervical classification system (UCCS) was recently described; however, an independent agreement assessment has not been performed.

PURPOSE

To perform an independent evaluation of the AOSpine UCCS.

STUDY DESIGN

Agreement study.

PATIENT SAMPLE

Eighty four patients with upper cervical spine injuries.

OUTCOME MEASURES

Inter-observer agreement; intra-observer agreement.

METHODS

Complete imaging studies of 84 patients with upper cervical spine injuries, including all morphological types of injuries defined by the AOSpine UCCS were selected and classified by six evaluators (from three different countries). The 84 cases were presented to the same raters randomly after a 4-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement.

RESULTS

The interobserver agreement was almost perfect when considering the fracture site (I, II or III), with κ=0.82 (0.78-0.83), but the agreement according to the site and type level was moderate, κ=0.57 (0.55-0.65). The intra-observer agreement was almost perfect considering the injury, with κ=0.83 (0.78-0.86), while according to site and type was substantial, κ=0.69 (0.67-0.71).

CONCLUSIONS

We observed only a moderate inter-observer agreement using this classification. We believe our results can be explained because this classification attempted to organize many different injury types into a single scheme.

Myositis ossificans of the longus coli muscle following cervical spine fracture-dislocation

BACKGROUND

Upper cervical spine fractures are traumatic injuries typically associated with high-energy trauma and have a high morbidity and mortality rate. We describe a case of upper cervical spine fracture occurring due to high-energy trauma that resulted in significant myositis ossificans (MO) of the longus coli muscle.

STUDY DESIGN

Case Report and literature review.

METHODS

Retrospective review of medical records.

RESULTS

The patient was treated non-operatively for the neck rotation and MO of his longus coli muscle and had gradual improvement of symptoms.

CONCLUSIONS

To our knowledge, this is the first report of symptomatic MO of the longus coli following traumatic cervical spine fracture in an adult. Treatment with supportive measures appears to achieve satisfactory outcome.