title: A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article.
abstract: OBJECTIVE
  Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies. The authors' objective was to establish a universal nomenclature for cervical spine osteotomies to provide a common language among spine surgeons.
  
  
  METHODS
  A proposed nomenclature with 7 anatomical grades of increasing extent of bone/soft tissue resection and destabilization was designed. The highest grade of resection is termed the major osteotomy, and an approach modifier is used to denote the surgical approach(es), including anterior (A), posterior (P), anterior-posterior (AP), posterior-anterior (PA), anterior-posterior-anterior (APA), and posterior-anterior-posterior (PAP). For cases in which multiple grades of osteotomies were performed, the highest grade is termed the major osteotomy, and lower-grade osteotomies are termed minor osteotomies. The nomenclature was evaluated by 11 reviewers through 25 different radiographic clinical cases. The review was performed twice, separated by a minimum 1-week interval. Reliability was assessed using Fleiss kappa coefficients.
  
  
  RESULTS
  The average intrarater reliability was classified as "almost perfect agreement" for the major osteotomy (0.89 [range 0.60-1.00]) and approach modifier (0.99 [0.95-1.00]); it was classified as "moderate agreement" for the minor osteotomy (0.73 [range 0.41-1.00]). The average interrater reliability for the 2 readings was the following: major osteotomy, 0.87 ("almost perfect agreement"); approach modifier, 0.99 ("almost perfect agreement"); and minor osteotomy, 0.55 ("moderate agreement"). Analysis of only major osteotomy plus approach modifier yielded a classification that was "almost perfect" with an average intrarater reliability of 0.90 (0.63-1.00) and an interrater reliability of 0.88 and 0.86 for the two reviews.
  
  
  CONCLUSIONS
  The proposed cervical spine osteotomy nomenclature provides the surgeon with a simple, standard description of the various cervical osteotomies. The reliability analysis demonstrated that this system is consistent and directly applicable. Future work will evaluate the relationship between this system and health-related quality of life metrics.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.forename: Bertrand
authors.initials: B
authors.lastname: Moal
authors.forename: Themistocles
authors.initials: T
authors.lastname: Protopsaltis
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.forename: Eric
authors.initials: E
authors.lastname: Klineberg
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.forename: Robert
authors.initials: R
authors.lastname: Hart
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery; D032921:Consensus; D006801:Humans; D010027:Osteotomy / Q000145:classification* / Q000379:methods; D013121:Spinal Curvatures / Q000145:classification / Q000601:surgery; D009626:Terminology as Topic