Browsing by Author "Schoenfeld, Andrew"

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    Reliability and reproducibility of subaxial cervical injury description system: a standardized nomenclature schema.
    (Spine, 2011-08) Bono, Christopher M; Schoenfeld, Andrew; Gupta, Giri; Harrop, James S; Anderson, Paul; Patel, Alpesh A; Dimar, John; Aarabi, Bizhan; Dailey, Andrew; Vaccaro, Alexander R; Gahr, Ralf; Shaffrey, Christopher; Anderson, David G; Rampersaud, Raj

    Study design

    Radiographic measurement study.

    Objective

    To develop a standardized cervical injury nomenclature system to facilitate description, communication, and classification among health care providers. The reliability and reproducibility of this system was then examined.

    Summary of background data

    Description of subaxial cervical injuries is critical for treatment decision making and comparing scientific reports of outcomes. Despite a number of available classification systems, surgeons, and researchers continue to use descriptive nomenclature, such as "burst" and "teardrop" fractures, to describe injuries. However, there is considerable inconsistency with use of such terms in the literature.

    Methods

    Eleven distinct injury types and associated definitions were established for the subaxial cervical spine and subsequently refined by members of the Spine Trauma Study Group. A series of 18 cases of patients with a broad spectrum of subaxial cervical spine injuries was prepared and distributed to surgeon raters. Each rater was provided with the full nomenclature document and asked to select primary and secondary injury types for each case. After receipt of the raters' first round of classifications, the cases were resorted and returned to the raters for a second round of review. Interrater and intrarater reliabilities were calculated as percent agreement and Cohen kappa (κ) values. Intrarater reliability was assessed by comparing a given rater's diagnosis from the first and second rounds.

    Results

    Nineteen surgeons completed the first and second rounds of the study. Overall, the system demonstrated 56.4% interrater agreement and 72.8% intrarater agreement. Overall, interrater κ values demonstrated moderate agreement while intrarater κ values showed substantial agreement. Analyzed by injury types, only four (burst fractures, lateral mass fractures, flexion teardrop fractures, and anterior distraction injuries) demonstrated greater than 50% interrater agreement.

    Conclusion

    This study demonstrated that, even in ideal circumstances, there is only moderate agreement among raters regarding cervical injury nomenclature. It is hoped that more familiarity with the proposed system will increase reproducibility in the future. Additional research is required to establish the clinical utility of this novel nomenclature schema.
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    The Benefit of Addressing Malalignment In Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery.
    (Spine, 2022-09) Passias, Peter G; Krol, Oscar; Williamson, Tyler K; Lafage, Virginie; Lafage, Renaud; Smith, Justin S; Line, Breton; Vira, Shaleen; Lipa, Shaina; Daniels, Alan; Diebo, Bassel; Schoenfeld, Andrew; Gum, Jeffrey; Kebaish, Khaled; Park, Paul; Mundis, Gregory; Hostin, Richard; Gupta, Munish C; Eastlack, Robert; Anand, Neel; Ames, Christopher; Hart, Robert; Burton, Douglas; Schwab, Frank J; Shaffrey, Christopher; Klineberg, Eric; Bess, Shay; International Spine Study Group

    Study design

    Retrospective cohort study.

    Objective

    Understand the benefit of addressing malalignment in revision surgery for PJK.

    Summary of background data

    Proximal junctional kyphosis(PJK) is a common cause of revision surgery for ASD patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbo-pelvic mismatch.

    Methods

    Recurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor(proximal extension of fusion alone compared to combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbo-pelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria(Global Alignment and Proportionality[GAP],Roussouly-type, and Sagittal Age-Adjusted Score[SAAS]).

    Results

    151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP post-revision had lower rates of recurrent PJK(23% vs. 42%;OR: 0.3,95% CI:[0.1-0.8];P=0.024). Following adjusted analysis, patients who were ideally aligned in 1 of 3 criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%;OR: 0.4,95% CI:[0.1-0.9];P=0.035) and recurrent PJF(OR: 0.1,95% CI:[0.02-0.7];P=0.015). Patients ideally aligned in 2 of 3 criteria avoid any development of PJF(0% vs. 16%, P<0.001).

    Conclusion

    Following revision surgery for proximal junctional kyphosis, patients with persistent poor sagittal alignment showed increased rates of recurrent proximal junctional kyphosis compared with patients who had abnormal lumbo-pelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial.