Browsing by Author "Camino, Gaston"
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Publication An independent inter- and intra-observer agreement assessment of the AOSpine upper cervical injury classification system(2022) Urrutia, Julio; Delgado, Byron; Camino, Gaston; Guiroy, Alfredo; Astur, Nelson; Valacco, Marcelo; Zamorano, Juan; Vidal, Catalina; Yurac, RatkoBackground context: The complex anatomy of the upper cervical spine resulted in numerous separate classification systems of upper cervical spine trauma. The AOSpine upper cervical classification system (UCCS) was recently described; however, an independent agreement assessment has not been performed. Purpose: To perform an independent evaluation of the AOSpine UCCS. Study design: Agreement study. Patient sample: Eighty four patients with upper cervical spine injuries. Outcome measures: Inter-observer agreement; intra-observer agreement. Methods: Complete imaging studies of 84 patients with upper cervical spine injuries, including all morphological types of injuries defined by the AOSpine UCCS were selected and classified by six evaluators (from three different countries). The 84 cases were presented to the same raters randomly after a 4-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement. Results: The interobserver agreement was almost perfect when considering the fracture site (I, II or III), with κ=0.82 (0.78-0.83), but the agreement according to the site and type level was moderate, κ=0.57 (0.55-0.65). The intra-observer agreement was almost perfect considering the injury, with κ=0.83 (0.78-0.86), while according to site and type was substantial, κ=0.69 (0.67-0.71). Conclusions: We observed only a moderate inter-observer agreement using this classification. We believe our results can be explained because this classification attempted to organize many different injury types into a single scheme.Publication AO Spine-DGOU Osteoporotic Fracture Classification System: Internal Validation by the AO Spine Knowledge Forum Trauma(2024) Scherer, Julian; Joaquim, Andrei; Vaccaro, Alex; Kanna, Rishi; El-Sharkawi, Mohammad; Takahata, Masahiko; Aly, Mohamed; Camino, Gaston; Spiegl, Ulrich; Oner, Cumhur; Canseco, Jose; Yurac, Ratko; Benneker, Lorin; Popescu, Eugen; Bransford, Richard; Chhabra, Harvinder; Kandziora, Frank; Neva, Marko; Schnake, KlausStudy design: Cross-sectional survey. Objectives: Injury classifications are important tools to identify fracture patterns, guide treatment-decisions and aid to identify optimal treatment plans. The AO Spine-DGOU Osteoporotic Fracture (OF) classification system was developed, and the aim of this study was to assess the reliability of this new classification system. Methods: 23 Members of the AO Spine Knowledge Forum Trauma participated in the validation process. Participants were asked to rate 33 cases according to the OF classification at 2 time points, 4 weeks apart (assessment 1 and 2). The kappa statistic (κ) was calculated to assess inter-observer reliability and intra-rater reproducibility. The gold master key for each case was determined by approval of at least 5 out of 7 members of the DGOU. Results: A total of 1386 ratings (21 raters) were performed. The overall inter-rater agreement was moderate with a combined kappa statistic for the OF classification of 0.496 in assessment 1 and 0.482 in assessment 2. The combined percentage of correct ratings (compared to gold-standard) in assessment 1 was 71.4% and 67.4% in assessment 2. The average intra-rater reproducibility was substantial (κ = 0.74, median 0.76, range 0.55 to 1.00, SD 0.13) for the assessed fracture types. Conclusions: The assessed overall inter-rater reliability was moderate and substantial in some instances. The average intra-rater reproducibility is substantial. It seems that appropriate training of the classification system can enhance inter- and intra-rater reliability.Publication Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons(2021) Meissner, Arturo; Diaz, Claudio; Klaber, Ianiv; Zamora, Tomas; Valencia, Manuel; Camino, Gaston; Astu, Nelson; Yurac, Ratko; Valacco, Marcelo; Urrutia, JulioBackground: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons. Methods: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient (κ) was used to measure the inter-and intra-observer agreement. Results: The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons (κ= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons (κ= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with κ= 0.52 (0.49 - 0.54) for spine surgeons and κ= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons (κ= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons (κ= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, κ= 0.61 (0.56 - 0.67) for spine surgeons and κ= 0.68 (0.62 - 0.74) for pelvic trauma surgeons. Conclusion: This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures.Publication Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders(2024) Joaquim, Andrei; Bigdon, Sebastian; Bransford, Richard; Chhabra, Harvinder; Yurac, Ratko; Kumar, Vishal; El-Sharkawi, Mohammad; Benneker, Lorin; Karamian, Brian; Canseco, Jose; Scherer, Julian; Hassan, Ahmed; Schroeder, Gregory; Öner, Cumhur; Rajasekaran, Shanmuganathan; Vialle, Emiliano; Kanna, Rishi; Vaccaro, Alexander; Tee, Jin; Camino, Gaston; Fisher, Charles; Dvorak, Marcel; Schnake, Klaus; AO Spine Knowledge Forum Trauma & InfectionStudy design: Literature review with clinical recommendations. Objective: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. Methods: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. Results: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.