title: Differences between neurosurgeons and orthopedic surgeons in classifying cervical dislocation injuries and making assessment and treatment decisions: a multicenter reliability study.
abstract: Variability exists in the management of cervical spinal injuries. The goal of this study was to assess the effect of training specialty (orthopedic surgery vs neurosurgery) on management of cervical dislocations. Twenty-nine spine surgeons reviewed 10 cases of cervical dislocation injuries. For each of the 10 cases, the surgeons evaluated 3 clinical scenarios, which included a neurologically intact patient, a patient with an incomplete spinal cord injury (SCI), and a patient with complete SCI. Surgeons determined whether a unilateral or bilateral facet dislocation was present and whether pretreatment magnetic resonance imaging (MRI) or immediate closed reduction was indicated. Management decisions were re-assessed after review of MRIs. While spine surgeons may agree on what they see on MRI and how they classify certain cervical injuries irrespective of training, significant differences of opinion continue to exist regarding the therapeutic implications of this information, specifically, whether to order a pretreatment MRI and how to manage the injury.
authors.affiliation: Spinal Cord Injury Center, University of Kansas Medical Center, Kansas City, 66160, USA. parnold@kumc.edu
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
authors.forename: Y Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
authors.forename: Marcel F S
authors.initials: MF
authors.lastname: Dvorak
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
authors.forename: Jared T
authors.initials: JT
authors.lastname: Wilsey
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nassr
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009493:Neurosurgery / Q000592:standards*; D019635:Neurosurgical Procedures / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods; D009985:Orthopedics / Q000592:standards*; D013124:Spinal Injuries / Q000145:classification* / Q000175:diagnosis / Q000628:therapy*; D011795:Surveys and Questionnaires; D015599:Trauma Severity Indices