Browsing by Author "Joaquim, Andrei"
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Item Accuracy and reliability of the AO Spine subaxial cervical spine classifcation system grading subaxial cervical facet injury morphology(2021) Cabrera, Juan; Yurac, Ratko; Guiroy, Alfredo; Joaquim, Andrei; Carazzo, Charles; Zamorano, Juan; White, Kevin; Valacco, Marcelo; The AO Spine Latin America Trauma Study GroupPurpose: A classification system was recently developed by the international association AO Spine for assessing subaxial cervical spine fractures. Significant variability exists between users of the facet component, which consists of four morphological types (F1-F4). The primary aims of this study were to assess the diagnostic accuracy and reliability of this new system's facet injury morphological classifications. Methods: A survey consisting of 16 computed tomography (CT) scans of patients with cervical facet fractures was distributed to spine surgeon members of AO Spine Latin America. To provide a gold standard diagnosis for comparison, all 16 injuries had been classified previously by six co-authors and only were included after total consensus was achieved. Demographic and surgical practice characteristics of all respondents were analyzed, and diagnostic accuracy calculated. Inter- and intra-observer agreement rates were calculated across two survey rounds, conducted one month apart. Results: A total of 135 surgeons completed both surveys, among whom the mean age was 41.6 years (range 26-71), 130 (96.3%) were men, and 83 (61.5%) were orthopedic surgeons. The mean time in practice as a spine surgeon was 9.7 years (1-30). The overall diagnostic accuracy of all responses was 65.4%. Inter-observer and intra-observer agreement rates for F1/F2/F3/F4 were 55.4%/47.6%/64.0%/94.7% and 60.0%/49.1%/58.0%/93.0%, respectively. Conclusion: This study evaluates the AO Spine Classification System specifically for facet injuries involving the subaxial cervical spine in a large sample of spine surgeons. There was significant variability in diagnostic accuracy for F1 through F3-type fractures, whereas almost universal agreement was achieved for F4-type injuries.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.Item CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?(2021) Cabrera, Juan; Yurac, Ratko; Joaquim, Andrei; Guiroy, Alfredo; Carazzo, Charles; Zamorano, Juan; Valacco, Marcelo; And the AO Spine Latin America Trauma Study GroupObjectives: Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. Methods: A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. Results: There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. Conclusions: Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.Publication Reliability Evaluation of the New AO Spine-DGOU Classification for Osteoporotic Thoracolumbar Fractures(2022) Quinteros, Guisela; Cabrera, Juan; Urrutia, Julio; Carazzo, Charles; Guiroy, Alfredo; Marre, Bartolome; Joaquim, Andrei; Yurac, RatkoObjectives: To perform an interobserver and intraobserver agreement evaluation of the new AO Spine-DGOU classification system for osteoporotic thoracolumbar fractures (OFc). Methods: Complete imaging studies of 97 patients (radiographs, computed tomography scans, and magnetic resonance imaging) with osteoporotic thoracolumbar fractures were selected and classified using the OFc by 6 spine surgeons (3 senior surgeons with more than 15 years of experience and 3 surgeons with less than 15 years). After a 4-week interval, the same cases were presented to the same evaluators in a random sequence for a new classification assessment. The weighted kappa coefficient (wκ) was used to determine the interobserver and intraobserver agreement. Results: The interobserver agreement was moderate, wκ = 0.59 (95% confidence interval 0.54-0.64). The intraobserver agreement was fair, wκ = 0.35 (95% confidence interval 0.29-0.40). Interobserver agreement slightly improved for junior staff between first and second evaluation, suggesting a learning effect. Better agreement was obtained by senior staff at the interobserver and intraobserver agreement. Conclusions: This independent assessment demonstrated that new OFc allows moderate interobserver agreement and fair intraobserver agreement. Further studies are necessary prior to its widespread adoption.Publication Risk Factors for Failure of Non-operative Management in Isolated Unilateral Non-displaced Facet Fractures of the Subaxial Cervical Spine: Systematic Review and Meta-Analysis(2024) Cirillo, Ignacio; Ricciardi, Alejandro; Cabrera, Juan Pablo; López Muñoz, Felipe; Romero Vlverde, Lyanne; Joaquim, Andrei; Carazzo, Charles; Yurac, RatkoStudy Design: systematic review.Objective: To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures ofthe subaxial cervical spine in neurologically intact patients.Methods: A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order todetermine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxialcervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with thePRISMA Statement and registered on PROSPERO (CRD42023405699).Results: A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databaseswere included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, aserious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to lesscomplex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operativemanagement (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture heightand non-operative treatment success [Fracture height (percentage) Mean Difference = 17.51 ( 28.22, 6.79 95% CI); Absolute height Mean Difference: 0.46 ( 0.60, 0.31 95% CI)]. Other risk factors were not included in the meta-analysis dueto lack of data. The level of certainty was rated as “very low”.Conclusions: Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute termsor as a percentage) are significant risk factors for failure of non-operative treatment.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.Item Time to Surgery for Unstable Thoracolumbar Fractures in Latin America—A Multicentric Study(2021) Guiroy, Alfredo; Carazzo, Charles; Zamorano, Juan; Cabrera, Juan; Joaquim, Andrei; Guasque, Joana; Sfredo, Ericson; White, Kevin; Yurac, Ratko; Falavigna, AsdrubalObjective We sought to identify delays for surgery to stabilize unstable thoracolumbar fractures and the main reasons for them across Latin America. Methods We reviewed the charts of 547 patients with type B or C thoracolumbar fractures from 21 spine centers across 9 Latin American countries. Data were collected on demographics, mechanism of trauma, time between hospital arrival and surgery, type of hospital (public vs. private), fracture classification, spinal level of injury, neurologic status (American Spinal Injury Association impairment scale), number of levels instrumented, and reason for delay between hospital arrival and surgical treatment. Results The sample included 403 men (73.6%) and 144 women (26.3%), with a mean age of 40.6 years. The main mechanism of trauma was falls (44.4%), followed by car accidents (24.5%). The most frequent pattern of injury was B2 injuries (46.6%), and the most affected level was T12-L1 (42.2%). Neurologic status at admission was 60.5% intact and 22.9% American Spinal Injury Association impairment scale A. The time from admission to surgery was >72 hours in over half the patients and over a week in >25% of them. The most commonly reported reasons for surgical delay were clinical instability (22.9%), lack of operating room availability (22.7%), and lack of hardware for spinal instrumentation (e.g., screws/rods) (18.8%). Conclusions Timing for surgery in this sample of unstable fractures was over 72 hours in more than half of the sample and longer than a week in about a quarter. The main reasons for this delay were clinical instability and lack of economic resources. There is an apparent need for increased funding for the treatment of spinal trauma patients in Latin America.Publication Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation(2022) Cabrera, Juan; Guiroy, Alfredo; Carazzo, Charles; Yurac, Ratko; Valacco, Marcelo; Vialle, Emiliano; Joaquim, Andrei; On behalf of the AO Spine Latin America Trauma Study Group