title: A Worldwide Analysis of the Reliability and Perceived Importance of an Injury to the Posterior Ligamentous Complex in AO Type A Fractures.
abstract: Study Design Survey of spine surgeons. Objective To determine the reliability with which international spine surgeons identify a posterior ligamentous complex (PLC) injury in a patient with a compression-type vertebral body fracture (type A). Methods A survey was sent to all AOSpine members from the six AO regions of the world. The survey consisted of 10 cases of type A fractures (2 subtype A1, 2 subtype A2, 3 subtype A3, and 3 subtype A4 fractures) with appropriate imaging (plain radiographs, computed tomography, and/or magnetic resonance imaging), and the respondent was asked to identify fractures with a PLC disruption, as well as to indicate if the integrity of the PLC would affect their treatment recommendation. Results Five hundred twenty-nine spine surgeons from all six AO regions of the world completed the survey. The overall interobserver reliability in determining the integrity of the PLC was slight (kappa = 0.11). No substantial regional or experiential difference was identified in determining PLC integrity or its absence; however, a regional difference was identified (p < 0.001) in how PLC integrity influenced the treatment of type A fractures. Conclusion The results of this survey indicate that there is only slight international reliability in determining the integrity of the PLC in type A fractures. Although the biomechanical importance of the PLC is not in doubt, the inability to reliably determine the integrity of the PLC may limit the utility of the M1 modifier in the AOSpine Thoracolumbar Spine Injury Classification System.
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: John D
authors.initials: JD
authors.lastname: Koerner
authors.affiliation: Department of Orthopaedic Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: F Cumhur
authors.initials: FC
authors.lastname: Oner
authors.affiliation: Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, United States.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Klinikum Suedstadt Rostock, Rostock, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Reinhold
authors.affiliation: Berufsgenossenschaftliche Unfallklinik Frankfurt, Center for Spinal Surgery and Neurotraumatology, Department of Orthopaedic Surgery, Frankfurt/Main, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Kandziora
authors.affiliation: Department of Orthopaedic Surgery, University of Washington/Harborview Medical Center, Seattle, Washington, United States.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States.
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Department of Orthopaedic Surgery, Catholic University, Curitiba, Brazil.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Vialle
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
keywords: AOSpine Thoracolumbar Spine Injury Classification System; M1 modifier; PLC; posterior ligamentous complex; reliability