Teachability and reliability of a new classification system for lower cervical spinal injuries.

STUDY DESIGN: Reliability and validation study. OBJECTIVE: The objective of this study is to evaluate a new lower cervical spine injury classification system and assess its reliability, teachability, and clinical applications. SUMMARY OF BACKGROUND DATA: The recently proposed Cervical Spine Injury Severity Score (CSISS) morphologically describes lower cervical spine injuries and grades them on a score of 1 to 20 depending on the integrity of the 4 columns that make up the cervical spine. Early data suggests that this classification system is both reliable and reproducible. Reliability data from additional institutions and data exploring teachability of this classification system is not available. METHODS: Fifteen subjects (12 residents and 3 attendings trained in the management of spinal trauma) reviewed radiographs and CT scans of 50 patients and scored them according to the CSISS. Six residents scored the patients 1 month before an instructional lecture given by the senior author and then again immediately following the lecture to assess teachability of the new classification system. All subjects then reviewed the films a final time 1 month later to assess both intraobserver and interobserver reliability. The patients' scores were also analyzed in conjunction with their clinical treatment. RESULTS: Interobserver reliability overall was excellent (0.975) with junior residents performing similarly to those with more extensive training. Intraobserver reliability was also excellent overall (0.983). Teachability scores improved in the ability to score all 4 columns. Furthermore, this classification system was a fair overall predictor of surgical candidates as a score of 7 predicted 19 out of 26 surgical patients (76% sensitivity, 100% specificity). CONCLUSION: The CSISS is a useful new adjunct in the treatment and classification of lower cervical spine injuries. The system is reliable, reproducible, and teachable. It is clinically useful for all levels of orthopedic training and experience.

Radiographic assessment of lumbar facet distance spacing and pediatric spondylolysis.

STUDY DESIGN: Retrospective radiographic review. OBJECTIVE: The purpose of this article was to explore the relationship between interfacet spacing and pediatric spondylolysis. SUMMARY OF BACKGROUND DATA: Recent literature suggests that a potential cause of spondylolytic defects in adults is a narrowed interfacet spacing in the lower lumbar spine. This lack of space places them at increased risk for pars fractures with repetitive lumbar hyperextension. This relationship has not been explored in a pediatric population. METHODS: The anteroposterior lumbar spine radiographs of 41 pediatric patients with spondylolytic defects were compared with 41 unaffected controls. A standard digital caliper was used to measure interfacet distance. Vertebral body width and interpedicular distance were recorded as internal standards to control for varying vertebral size. Statistical analysis exploring the relationships of interfacet distances between the affected and unaffected groups was performed using a Mann-Whitney U test. RESULTS: The absolute increase in interfacet distance between adjacent levels was significantly smaller at the L4/L5 level in spondylolytic individuals (P = 0.023). When interpedicular distance was used to standardize for vertebral body size, a significantly smaller increase in the interpedicular distance was noted at the L4/5 level in spondylolytic individuals (P = 0.026). Similar results were obtained when body width was used to standardize for vertebral body size (P < 0.001). A similar trend was noticed at the L3/4 level when standardizing with interpedicular distance although these results were not significant (P = 0.098). CONCLUSION: A likely explanation for the etiology of lumbar pars defects is insufficient caudal increase in lumbar interfacet spacing. Further prospective studies are necessary to determine if unaffected individuals with a narrowed interfacet spacing are at increased risk of developing spondylolytic defects later in life.

Vacuum-assisted wound closure in postoperative spinal wound infection.

Combined with antibiotic therapy, vacuum-assisted wound closure may help reduce the need for serial irrigation and debridement surgery, contributing to a decrease in overall hospital stay.