Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons

Miguel Pishnamaz; Inez Curfs; Daniel Uhing; Christian Herren; Henk van Santbrink; Christian A. Mueller; Matti Scholz; Philipp Lichti; Kim Rijkers; Toon F. Boselie; Frank Hildebrand; Paul C. Willems; Philipp Kobbel

doi:10.1016/j.wneu.2018.11.078

Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons

Miguel Pishnamaz^*, Inez Curfs, Daniel Uhing, Christian Herren, Henk van Santbrink, Christian A. Mueller, Matti Scholz, Philipp Lichti, Kim Rijkers, Toon F. Boselie, Frank Hildebrand, Paul C. Willems, Philipp Kobbel

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: To date, no evidence-based treatment algorithm is available for fractures of the subaxial spine. The aim of the present study was to assess and compare the management strategy for traumatic subaxial fractures among German and Dutch spine surgeons.

METHODS: In our web-based multicenter study, German and Dutch spine surgeons evaluated the computed tomography data of traumatic subaxial fractures (C3-C7). Supplementary case-specific information was provided. The fractures were classified using the AO spine classification. Next, 9 questions concerning the treatment algorithm were evaluated. Data were analyzed using SPSS. Statistical significance was defined as P <0.05.

RESULTS: Ten surgeons (5/country) evaluated 31 cases (310 votes). The fractures were classified as AO type A in 37% (114 votes), type B in 50% (155 votes), and type C in 13% (41 votes). German spine surgeons had a lower threshold concerning the indication for surgical treatment (German, 94.2% vs. Netherlands, 58.1%; P <0.05). A consensus was present for operative stabilization for type B and C injuries, but a discrepancy was found in the therapeutic algorithm for type A fractures. The most significant difference was seen in the treatment of type A2 and A3 fractures (surgery for type A2/A3 fracture: German, 92.9% vs. Netherlands, 5.3%; P <0.05).

CONCLUSION: We found a consensus for the stabilization of AO type B and C fractures but country-specific differences in the treatment of type A fractures, especially for A2 and A3 fractures. Further evidence is necessary to ensure more consistent international treatment strategies.

Original language	English
Pages (from-to)	E125-E132
Number of pages	8
Journal	World Neurosurgery
Volume	123
DOIs	https://doi.org/10.1016/j.wneu.2018.11.078
Publication status	Published - Mar 2019

Keywords

AO spine classification
International
Interobserver
Multicenter
Spine trauma
Subaxial cervical spine
INJURIES
REPRODUCIBILITY
AGREEMENT
ANTERIOR
CARE

Access to Document

10.1016/j.wneu.2018.11.078

Cite this

Pishnamaz, M., Curfs, I., Uhing, D., Herren, C., van Santbrink, H., Mueller, C. A., Scholz, M., Lichti, P., Rijkers, K., Boselie, T. F., Hildebrand, F., Willems, P. C., & Kobbel, P. (2019). Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons. World Neurosurgery, 123, E125-E132. https://doi.org/10.1016/j.wneu.2018.11.078

@article{247653008c704d72bf70addda7971883,

title = "Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons",

abstract = "BACKGROUND: To date, no evidence-based treatment algorithm is available for fractures of the subaxial spine. The aim of the present study was to assess and compare the management strategy for traumatic subaxial fractures among German and Dutch spine surgeons.METHODS: In our web-based multicenter study, German and Dutch spine surgeons evaluated the computed tomography data of traumatic subaxial fractures (C3-C7). Supplementary case-specific information was provided. The fractures were classified using the AO spine classification. Next, 9 questions concerning the treatment algorithm were evaluated. Data were analyzed using SPSS. Statistical significance was defined as P <0.05.RESULTS: Ten surgeons (5/country) evaluated 31 cases (310 votes). The fractures were classified as AO type A in 37% (114 votes), type B in 50% (155 votes), and type C in 13% (41 votes). German spine surgeons had a lower threshold concerning the indication for surgical treatment (German, 94.2% vs. Netherlands, 58.1%; P <0.05). A consensus was present for operative stabilization for type B and C injuries, but a discrepancy was found in the therapeutic algorithm for type A fractures. The most significant difference was seen in the treatment of type A2 and A3 fractures (surgery for type A2/A3 fracture: German, 92.9% vs. Netherlands, 5.3%; P <0.05).CONCLUSION: We found a consensus for the stabilization of AO type B and C fractures but country-specific differences in the treatment of type A fractures, especially for A2 and A3 fractures. Further evidence is necessary to ensure more consistent international treatment strategies.",

keywords = "AO spine classification, International, Interobserver, Multicenter, Spine trauma, Subaxial cervical spine, INJURIES, REPRODUCIBILITY, AGREEMENT, ANTERIOR, CARE",

author = "Miguel Pishnamaz and Inez Curfs and Daniel Uhing and Christian Herren and {van Santbrink}, Henk and Mueller, {Christian A.} and Matti Scholz and Philipp Lichti and Kim Rijkers and Boselie, {Toon F.} and Frank Hildebrand and Willems, {Paul C.} and Philipp Kobbel",

note = "Publisher Copyright: {\textcopyright} 2018 Elsevier Inc.",

year = "2019",

month = mar,

doi = "10.1016/j.wneu.2018.11.078",

language = "English",

volume = "123",

pages = "E125--E132",

journal = "World Neurosurgery",

issn = "1878-8750",

publisher = "Elsevier Science",

}

Pishnamaz, M, Curfs, I, Uhing, D, Herren, C, van Santbrink, H, Mueller, CA, Scholz, M, Lichti, P, Rijkers, K , Boselie, TF, Hildebrand, F, Willems, PC & Kobbel, P 2019, 'Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons', World Neurosurgery, vol. 123, pp. E125-E132. https://doi.org/10.1016/j.wneu.2018.11.078

TY - JOUR

T1 - Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures

T2 - An Internet-Based Multicenter Study Among Spine Surgeons

AU - Pishnamaz, Miguel

AU - Curfs, Inez

AU - Uhing, Daniel

AU - Herren, Christian

AU - van Santbrink, Henk

AU - Mueller, Christian A.

AU - Scholz, Matti

AU - Lichti, Philipp

AU - Rijkers, Kim

AU - Boselie, Toon F.

AU - Hildebrand, Frank

AU - Willems, Paul C.

AU - Kobbel, Philipp

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND: To date, no evidence-based treatment algorithm is available for fractures of the subaxial spine. The aim of the present study was to assess and compare the management strategy for traumatic subaxial fractures among German and Dutch spine surgeons.METHODS: In our web-based multicenter study, German and Dutch spine surgeons evaluated the computed tomography data of traumatic subaxial fractures (C3-C7). Supplementary case-specific information was provided. The fractures were classified using the AO spine classification. Next, 9 questions concerning the treatment algorithm were evaluated. Data were analyzed using SPSS. Statistical significance was defined as P <0.05.RESULTS: Ten surgeons (5/country) evaluated 31 cases (310 votes). The fractures were classified as AO type A in 37% (114 votes), type B in 50% (155 votes), and type C in 13% (41 votes). German spine surgeons had a lower threshold concerning the indication for surgical treatment (German, 94.2% vs. Netherlands, 58.1%; P <0.05). A consensus was present for operative stabilization for type B and C injuries, but a discrepancy was found in the therapeutic algorithm for type A fractures. The most significant difference was seen in the treatment of type A2 and A3 fractures (surgery for type A2/A3 fracture: German, 92.9% vs. Netherlands, 5.3%; P <0.05).CONCLUSION: We found a consensus for the stabilization of AO type B and C fractures but country-specific differences in the treatment of type A fractures, especially for A2 and A3 fractures. Further evidence is necessary to ensure more consistent international treatment strategies.

AB - BACKGROUND: To date, no evidence-based treatment algorithm is available for fractures of the subaxial spine. The aim of the present study was to assess and compare the management strategy for traumatic subaxial fractures among German and Dutch spine surgeons.METHODS: In our web-based multicenter study, German and Dutch spine surgeons evaluated the computed tomography data of traumatic subaxial fractures (C3-C7). Supplementary case-specific information was provided. The fractures were classified using the AO spine classification. Next, 9 questions concerning the treatment algorithm were evaluated. Data were analyzed using SPSS. Statistical significance was defined as P <0.05.RESULTS: Ten surgeons (5/country) evaluated 31 cases (310 votes). The fractures were classified as AO type A in 37% (114 votes), type B in 50% (155 votes), and type C in 13% (41 votes). German spine surgeons had a lower threshold concerning the indication for surgical treatment (German, 94.2% vs. Netherlands, 58.1%; P <0.05). A consensus was present for operative stabilization for type B and C injuries, but a discrepancy was found in the therapeutic algorithm for type A fractures. The most significant difference was seen in the treatment of type A2 and A3 fractures (surgery for type A2/A3 fracture: German, 92.9% vs. Netherlands, 5.3%; P <0.05).CONCLUSION: We found a consensus for the stabilization of AO type B and C fractures but country-specific differences in the treatment of type A fractures, especially for A2 and A3 fractures. Further evidence is necessary to ensure more consistent international treatment strategies.

KW - AO spine classification

KW - International

KW - Interobserver

KW - Multicenter

KW - Spine trauma

KW - Subaxial cervical spine

KW - INJURIES

KW - REPRODUCIBILITY

KW - AGREEMENT

KW - ANTERIOR

KW - CARE

U2 - 10.1016/j.wneu.2018.11.078

DO - 10.1016/j.wneu.2018.11.078

M3 - Article

C2 - 30465953

SN - 1878-8750

VL - 123

SP - E125-E132

JO - World Neurosurgery

JF - World Neurosurgery

ER -