An independent inter- and intraobserver agreement assessment of the AOSpine sacral fracture classification system

BACKGROUND CONTEXTThe AOSpine sacral classification scheme was recently described. It demonstrated substantial interobserver and excellent intraobserver agreement in the study describing it; however, an independent assessment has not been performed.PURPOSETo perform an independent inter- and intraobserver agreement evaluation of the AOSpine sacral fracture classification system.STUDY DESIGNAgreement study.METHODSComplete computerized tomography (CT) scans, including axial images, with coronal and sagittal reconstructions of 80 patients with sacral fractures were selected and classified using the morphologic grading of the AOSpine sacral classification system by six evaluators (from three different countries). Neurological modifiers and case-specific modifiers were not assessed. After a four-week interval, the 80 cases were presented to the same raters in a random sequence for repeat assessment. We used the Kappa coefficient (κ) to establish the inter- and intraobserver agreement.RESULTSThe interobserver agreement was substantial when considering the fracture severity types (A, B, or C), with κ=0.68 (0.63–0.72), but moderate when considering the subtypes: κ=0.52 (0.49–0.54). The intraobserver agreement was substantial considering the fracture types, with κ=0.69 (0.63–0.75), and considering subtypes, κ=0.61 (0.56–0.67).CONCLUSIONThe sacral classification system allows adequate interobserver agreement at the type level, but only moderate at the subtypes level. Future prospective studies should evaluate whether this classification system allows surgeons to decide the best treatment and to establish prognosis in patients with sacral fractures.     

Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell’s disease: a systematic review and meta-analysis

Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell’s disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)—vertebroplasty and/or kyphoplasty—is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA?+?SSF versus VA alone. Systematic review, including comparative articles in Kümmell’s disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA?+?SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA?+?SSF: MD –0.61, 95% CI (–1.44, 0.23), I² 91%, p?=?0.15; ODI, non-significant difference favoring VA?+?SSF: MD –9.85, 95% CI (–19.63, –0.07), I² 96%, p?=?0.05; AVH, VA?+?SSF had a non-significant difference over VA alone: MD –3.21 mm, 95% CI (–7.55, 1.14), I² 92%, p?=?0.15; LKA, non-significant difference favoring VA?+?SSF: MD –0.85°, 95% CI (–5.10, 3.40), I² 95%, p?=?0.70. There were higher operative time, blood loss, and hospital length of stay for VA?+?SSF (p?<?0.05), but with lower cement leakage (p?<?0.05). VA?+?SFF and VA alone are effective treatment modalities in Kümmell’s disease. VA?+?SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.

     

Setting for single position surgery: survey from expert spinal surgeons

Purpose

To describe a comprehensive setting of the different alternatives for performing a single position fusion surgery based on the opinion of leading surgeons in the field.

Methods

Between April and May of 2021, a specifically designed two round survey was distributed by mail to a group of leaders in the field of Single Position Surgery (SPS). The questionnaire included a variety of domains which were focused on highlighting tips and recommendations regarding improving the efficiency of the performance of SPS. This includes operation room setting, positioning, use of technology, approach, retractors specific details, intraoperative neuromonitoring and tips for inserting percutaneous pedicle screws in the lateral position. It asked questions focused on Lateral Single Position Surgery (LSPS), Lateral ALIF (LA) and Prone Lateral Surgery (PLS). Strong agreement was defined as an agreement of more than 80% of surgeons for each specific question. The number of surgeries performed in SPS by each surgeon was used as an indirect element to aid in exhibiting the expertise of the surgeons being surveyed.

Results

Twenty-four surgeons completed both rounds of the questionnaire. Moderate or strong agreement was found for more than 50% of the items. A definition for Single Position Surgery and a step-by-step recommendation workflow was built to create a better understanding of surgeons who are starting the learning curve in this technique.

Conclusion

A recommendation of the setting for performing single position fusion surgery procedure (LSPS, LA and PLS) was developed based on a survey of leaders in the field.