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Objective:To establish a radiological classification system for acute cervical spinal cord injury without fracture or dislocation in adults and evaluate its credibility.Methods:A retrospective case series study was performed to analyze the clinical and radiological data of 132 patients with acute cervical spinal cord injury without cervical fracture or dislocation admitted to Huashan Hospita，Fudan University from January 2010 to December 2018. There were 97 males and 35 females，aged 18-82 years［（57.4±17.8）years］. The radiological classification system of acute cervical spinal cord injury without fracture and dislocation in adults was established based on spinal cord compression and its compressors，and the disco-ligamentous complex（DLC）injury. The number，age and causes of injury of each subtype were further analyzed. Another 24 patients with acute cervical spinal cord injury without fracture and dislocation were collected and assessed to calculate the Kappa coefficient for credibility assessment in the radiological classification by orthopedic surgeons who did not participate in the establishment of the classification.Results:The radiological classification system of acute cervical spinal cord injury without fracture or dislocation in adults included types I-IV. Type I was the cervical spinal cord significantly compressed by the existed pathological factors such as the ossification of the posterior longitudinal ligament of the cervical spine and/or cervical spinal canal stenosis before the injury；Type II was the cervical spinal cord significantly compressed by traumatic disc herniation and/or epidural hematoma；Type III was the spinal cord without obvious compression，but with definite DLC injury；Type IV was the spinal cord without obvious compression，accompanied with no or only suspicious DLC injury. Type I and type II could be with or without DLC injury. Eighty-three patients（62.9%）were classified as type I，with the age of（62.2±15.7）years，and the main cause of injury was fall injury（37 patients，44.6%），followed by traffic injury（31 patients，37.3%）. Seventy patients（12.9%）were classified as type II，with the age of（55.8±13.4）years，and the traffic injury（9 patients，52.9%）and fall injury（5 patients，29.4%）were more common. Twenty-four patients（18.2%）were classified as type III，with the age of（53.6±16.3）years，and the main causes of injury were fall injury（9 patients，37.5%）and traffic injury（8 patients，33.3%）. Eight patients（6.1%）were classified as type IV，with the age of（37.4±11.6）years，and the main causes of injury were traffic injury（4 patients，50.0%）and sports injury（3 patients，37.5%）. The credibility assessment of the radiological classification of acute cervical spinal cord injury without fracture or dislocation in adults showed that the consistency percentage was 79.2%-87.5%（mean，81.2%）among different observers. The Kappa coefficient was 0.691-0.866（mean，0.789），and the credibility was basically credible（0.61-0.80）.Conclusions:The established radiological classification system of acute cervical spinal cord injury without fracture or dislocation in adults has a good degree of credibility. Variances in age and causes of injury of each type suggest a good guidance value for clinical classification of acute cervical spinal cord injury without fracture and dislocation in adults.
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PURPOSE: To study the availability of the radiological classification for incongruent hallux valgus deformities, which has been used as the key to the algorithm for selecting surgical options. MATERIALS AND METHODS: To determine radiological severity, 257 cases of incongruent hallux valgus deformities were studied. The hallux valgus angle (HVA) and the 1/2 intermetatarsal angle (IMA) were measured in each case. Following Mann's radiological classification system, the HVA and IMA were compared to determine any similarity in severity. The distal metatarsal articular angle (DMAA) was also measured to observe the extent of its effect on the incongruent deformity. RESULTS: The HVA was 36.1degrees on average (range, 16-60degrees) and the 1/2 IMA was 15.8degrees on average (range, 5-30degrees). In 126 cases (49.1%), the severity between the 1/2 IMA and HVA coincided with the index classification, whereas. 131 cases (50.9%) did not correspond. Overall, the severity of approximately half the cases, could not be graded. The DMAA was 15.6degrees on average (range, 0-40degrees) and 133 cases (51.8%) demonstrated a value above normal value (>15degrees). CONCLUSION: The radiological classification system used as a guide for surgical decision-making needs to be revised, due to the overt limits of correspondence between the severity of the 1/2 IMA and HVA. Because the HVA would be influenced by both the lateral subluxation and bony deformity around the first metatarsophalangeal joint, it is reasonable to consider these factors on the HVA as elements to be corrected individually, instead of the HVA alone.