title: Classification of lower cervical spine injuries.
abstract: METHODS
  Blinded assessment by multiple observers of consecutive case series.
  
  
  OBJECTIVE
  Measure the reliability of a new system of determining stability in subaxial cervical spine injuries.
  
  
  BACKGROUND
  Classification is fundamental to allow communication, determine prognosis, and direct treatment. Current systems have many limitations, including difficultly of use, lack of proven reliability and validity, and no assessment of stability. A new system to assess instability is proposed.
  
  
  METHODS
  A literature review of the most commonly described classification systems is reported. The Cervical Spine Injury Severity Score was tested for reliability by 10 examiners who graded 35 consecutive cases of cervical trauma. Plain radiographs and CT were saved as read using Efilm Lite in random order. Each was scored and intraobserver and interobserver agreement was measured using intraclass correlation coefficients (ICC).
  
  
  RESULTS
  Intraobserver agreement was excellent with ICC ranging from 0.97 to 0.99. Interobserver agreement was also excellent with mean 0.80 ranging from 0.75 to 0.98.
  
  
  CONCLUSIONS
  A new cervical spine classification system of injury is paramount to treatment and outcomes. A new system may increase reliability and therefore allow more accurate determination of stability and dictate treatment.
authors: MetroHealth Medical Center, Department of Orthopaedic Surgery, Cleveland, OH, USA.
authors: Timothy A
authors: TA
authors: Moore
authors: Alexander R
authors: AR
authors: Vaccaro
authors: Paul A
authors: PA
authors: Anderson