title: Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons.
abstract: OBJECTIVE
  The aims of this study were (1) to demonstrate the AOSpine thoracolumbar spine injury classification system can be reliably applied by an international group of surgeons and (2) to delineate those injury types which are difficult for spine surgeons to classify reliably.
  
  
  METHODS
  A previously described classification system of thoracolumbar injuries which consists of a morphologic classification of the fracture, a grading system for the neurologic status and relevant patient-specific modifiers was applied to 25 cases by 100 spinal surgeons from across the world twice independently, in grading sessions 1 month apart. The results were analyzed for classification reliability using the Kappa coefficient (κ).
  
  
  RESULTS
  The overall Kappa coefficient for all cases was 0.56, which represents moderate reliability. Kappa values describing interobserver agreement were 0.80 for type A injuries, 0.68 for type B injuries and 0.72 for type C injuries, all representing substantial reliability. The lowest level of agreement for specific subtypes was for fracture subtype A4 (Kappa = 0.19). Intraobserver analysis demonstrated overall average Kappa statistic for subtype grading of 0.68 also representing substantial reproducibility.
  
  
  CONCLUSIONS
  In a worldwide sample of spinal surgeons without previous exposure to the recently described AOSpine Thoracolumbar Spine Injury Classification System, we demonstrated moderate interobserver and substantial intraobserver reliability. These results suggest that most spine surgeons can reliably apply this system to spine trauma patients as or more reliably than previously described systems.
authors.affiliation: Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Koerner
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Friedberger Landstrasse 430, 60389, Frankfurt, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Kandziora
authors.affiliation: Ganga Hospital, Coimbatore, Tamil Nadu, India.
authors.forename: Shanmuganathan
authors.initials: S
authors.lastname: Rajasekaran
authors.affiliation: University of Maryland Medical Center, College Park, MD, USA.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: Catholic University of Parana, Curitiba, Brazil.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Vialle
authors.affiliation: University of Toronto Spine Program and Toronto Western Hospital, Toronto, ON, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Thomas Jefferson University and Rothman Institute, 925 Chesnut Street, 5th Floor, Philadelphia, PA, 19107, USA. gregdschroeder@gmail.com.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: Klinikum Suedstadt Rostock, Department of Orthopaedic and Trauma Surgery, Suedring 81, 18059, Rostock, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reinhold
authors.affiliation: Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt, Friedberger Landstrasse 430, 60389, Frankfurt/Main, Germany.
authors.forename: Klaus John
authors.initials: KJ
authors.lastname: Schnake
authors.affiliation: Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359798, Seattle, WA, 98104, USA.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
authors.affiliation: School of Medicine, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Cumhur Öner
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000145:classification; D013124:Spinal Injuries / Q000145:classification*; D066231:Surgeons / Q000592:standards; D013904:Thoracic Vertebrae / Q000293:injuries*
keywords: AOSpine Thoracolumbar Spine Injury Classification System; Global reliability; Interobserver reliability; Intraobserver reliability